PEM Chatt

In this “Rewind” episode, Toni sits down with retired pediatrician Dr. Margaret “Meg” Wang, who trained and practiced through the pre-vaccine and early-vaccine eras of pediatrics, including the 1989–1990 measles epidemic in New York City. Together, they walk us through what pediatrics looked like before Hib, pneumococcal, varicella, and rotavirus vaccines and what we might face again as vaccination rates fall and herd immunity wanes. You’ll hear vivid, frontline stories of: Hib meningitis, occult bacteremia, and epiglottitis in infants and toddlers, when full sepsis workups (blood, urine, CSF, IV antibiotics, 72-hr admissions) were standard for many febrile children through 36 months of age. “Old-school” periorbital and buccal cellulitis from Hib—bright red with a violaceous hue, toxic kids, high fevers, and automatic LP + admission. Measles in an actual epidemic: the prodrome with the “three Cs” (cough, coryza, conjunctivitis), Koplik spots, and that classic confluent, head-to-toe rash, plus why measles is not a mild illness. Varicella beyond the “nuisance rash”: super-itchy multi-stage lesions, serious skin infections, and a child who developed Staph aureus bacteremia and tricuspid valve endocarditis requiring open-heart surgery—all from chickenpox in an unvaccinated child. Rotavirus winters: the green, watery, diaper-filling diarrhea, relentless fluid losses, metabolic acidosis, hypoglycemia in infants, and frequent admissions—versus the near-disappearance of severe rotavirus disease after the vaccine. Clinically, Toni and Dr. Wang dig into: How fever protocols for 0–36 month-olds have evolved from routine full sepsis workups to today’s more nuanced approach with viral testing and inflammatory markers like CRP and procalcitonin. Bedside pattern recognition for epiglottitis (toxic, drooling, tripod positioning, chin thrust, neck extension) and why you never upset these kids or put a tongue blade in their mouth—just get them upright and straight to controlled intubation with anesthesia. The role of parental gut instinct and why “this is not my kid” should always make you pause and reassess. 🔑 Key Takeaways: Vaccines didn’t just reduce visit volumes; they completely changed inpatient and ED workflows, procedure rates (LPs!), and long-term morbidity (e.g., deafness after meningitis). As coverage declines, we won’t just see “more fevers”—we’ll see sicker kids, more invasive procedures, more admissions, and more preventable complications. Your vaccine counseling today is part of preventing tomorrow’s “Rewind” from becoming reality again. 📌 Call to Action: Hit play, then share this episode with a colleague, resident, or trainee who has never seen these diseases and thinks of measles or chickenpox as “mild.” Their future patients are counting on it. 💉🧠

In this episode of PEM CHATT, the focus is on febrile neonates, the first part of a two-part series on pediatric fever management. Host Toni speaks with Dr. Lindsay McHale, a pediatric emergency medicine physician, to discuss how historical protocols for managing febrile neonates have evolved with advances in vaccines, PCR testing, and maternal surveillance. The discussion covers the 2021 AAP guidelines for managing febrile neonates, the essential components of a fever workup, interpretation of test results, and the nuances of decision-making across neonatal age groups. Practical insights on performing lumbar punctures, antibiotic selection, and interpreting potentially confounding results, such as bloody CSF taps, are shared, along with real-life case examples that illustrate the complexities involved. The conversation aims to equip clinicians with an evidence-based approach to improve patient outcomes in various clinical settings. #PEM #NP #APP #PA #pediatrics #emergencymedicine #emergencynursepractitioner #fellowship #medicaleducation #podcast #children #nursepractitioner #clinicalpharmacists #febrileneonate #sickbabies #lumbarpuncture 00:00 Introduction to Febrile Neonates 00:57 Historical Management of Febrile Neonates 01:25 Advancements in Medicine and New Guidelines 02:23 Introducing Dr. Lindsay McHale 03:56 Defining Febrile Neonates 04:54 Managing Febrile Neonates in the ER 05:51 Cold Babies and Controversies 07:45 Treating Fever in Neonates 09:06 Inclusion and Exclusion Criteria for Febrile Neonate Protocol 10:27 Why Neonates Are High-Risk 11:40 Code 60: Rapid Response for Febrile Neonates 12:30 Hypothetical Case Study: Febrile Neonate 14:24 Parental Concerns and Communication 19:57 Detailed Workup and Testing 23:27 Antibiotic Choices for Neonates 25:13 Dosing Nuances in Neonatal Antibiotics 26:49 Tips for Performing Lumbar Punctures 30:25 Interpreting Test Results in Neonates 32:46 AAP Sepsis Protocol for Neonates 40:06 Managing Febrile Infants: Case Studies 44:18 Conclusion and Next Episode Preview LINKS: AAP Guideline https://publications.aap.org/pediatrics/article/148/2/e2021052228/179783/Evaluation-and-Management-of-Well-Appearing?autologincheck=redirected CHOP Algorithm https://www.chop.edu/clinical-pathway/febrile-infant-emergent-evaluation-clinical-pathway THE MISFITS https://drive.google.com/file/d/1gpUsQOxMlbuqI-6hBDcZEF5ckpJWhWWb/view?usp=sharing

🎉 In this special 1-year anniversary episode of PEM CHATT, host Toni Dobson reflects on the podcast’s growth and welcomes guest Dayna Jaynstein, PA, to discuss the critical topic of maternal mortality. Together, they explore why the U.S. has the highest maternal mortality rate among developed countries, highlight the unique risks for Black and Native women, and introduce ACOG’s new initiative to help non-OB providers recognize and manage OB emergencies. The episode covers key warning signs, the importance of asking about current pregnancy status and delivery within the last year, and practical algorithms for managing cardiovascular and hypertensive emergencies in pregnant and postpartum women. Listeners are encouraged to use these resources, advocate for patients, and share knowledge to help prevent maternal deaths. Link to ACOG website with algorithms: ACOG.org/obemergencies ⏰ Timeline: 0:00 – Welcome & 1-year anniversary celebration 2:00 – Podcast journey & gratitude to listeners 5:00 – Guest introduction: Dana Jane Dean, PA 7:00 – Maternal mortality stats & disparities 10:00 – ACOG’s new initiative explained 15:00 – Key questions for providers & identifying at-risk patients 20:00 – Cardiovascular emergencies in pregnancy 25:00 – Hypertensive emergencies & management tips 30:00 – Eclampsia, preeclampsia, and medication guidance 35:00 – Family-centered care & advocating for moms 40:00 – Resources, final thoughts, and next episode preview

In this episode of PEM CHATT, host Toni Dobson is joined by Dr. Sarah Sterner, a pediatric emergency medicine physician and medical director at Children's at Erlanger, to discuss chest pain in children. The discussion delves into the differences between pediatric and adult chest pain presentations, common causes, high-risk diagnoses, and appropriate workup strategies. The episode includes discussions on real-life case scenarios, covering conditions such as hypertrophic cardiomyopathy, myocarditis, pericarditis, pneumothorax, and more. Dr Sterner also discusses why it is important to admit children with persistent tachycardia. The importance of a systematic approach, thorough history-taking, and recognizing potential red flags in pediatric patients is highlighted. WATCH on YouTube: https://www.youtube.com/@PEMChatt 00:00 Introduction to PEM CHATT 00:19 Understanding Pediatric Chest Pain 01:28 Introducing Dr. Sarah Sterner 03:22 Common Causes of Chest Pain in Children 04:05 Don't Miss Diagnoses 05:03 Approach to Pediatric Chest Pain Workup 06:31 Case Study: 14-Year-Old Male with Chest Pain 11:54 Case Study: 5-Year-Old Female with Chest Pain 22:23 Understanding Myocarditis 23:05 Pericarditis in Children 24:59 Pneumonia Management 25:56 Case Study: 9-Year-Old with Chest Pain 29:25 Case Study: 16-Year-Old with Pneumothorax 32:19 Case Study: 15-Year-Old with Pneumomediastinum 35:03 Rare but Serious: ACS and PE in Kids 39:58 Conclusion and Final Thoughts

You can WATCH this episode now on YouTube! https://youtu.be/lH4dYBOVihc In this episode of PEM CHATT, Toni sits down with nurse practitioner, June Bryant, and Cheryl Fabor, Director of Education for the Dysautonomia Project, to discuss the common yet rarely diagnosed condition of dysautonomia. They focus on this impact, symptoms, and treatment options. The conversation sheds light on conditions like POTS that falls under the umbrella of dysautonomia. The discussion includes real-life patient scenarios, diagnostic criteria, and both non-pharmacological and pharmacological treatment options. The episode aims to educate providers and raise awareness of autonomic nervous system disorders, with a focus on understanding patients' experiences and symptoms. **The details of any patient encounters discussed in this episode have been changed to protect the privacy of patients. Resources: https://thedysautonomiaproject.org/ Cheryl Fabor, Director of Education for the Dysautonomia Project Contact information: cheryl@dysproject.org Book Referenced in Podcast: https://thedysautonomiaproject.org/get-a-book/ Reach out to Cheryl for a FREE copy! Follow PEM CHATT on Instagram, Facebook, and YouTube! https://www.instagram.com/pemchatt/ https://www.facebook.com/profile.php?id=61575207741783# https://youtu.be/lH4dYBOVihc Timeline: 00:00 Introduction to PEM CHATT 00:26 Understanding dysautonomia 00:55 Case Study: 16 y/o F with syncope 01:32 Meet the Experts: Cheryl Fabor and June Bryant 03:06 What is dysautonomia? 04:30 Common symptoms and misconceptions. 06:31 Prevalence and types of dysautonomia 08:27 Causes and triggers of dysautonomia 10:53 Diagnosing dysautonomia 16:49 Tilt table test explained 22:10 Non-pharm treatments 27:11 Pharmacologic treatments 28:47 Understanding patient symptoms and treatments 31:05 The role of mental health in dysautonomia 32:53 Challenges faced by adolescents with dysautonomia 34:09 Parental involvement in misconceptions 34:50 Lack of education among healthcare providers 34:50 Recovery and management of dysautonomia 39:20 Case study discussed 45:59 Resources and support for dysautonomia 50:02 Conclusion and final thoughts NEXT MONTH: Dr Dan France from Vanderbilt University will be sitting down with Toni to discuss Mental Models and how they shape the way we think and interact with others.

In this episode of PEM Chatt, Toni talks with Dr. Whitney Buss about Diabetic Ketoacidosis (DKA) in children. Dr. Buss, a pediatric emergency medicine doctor and type 1 diabetic herself, shares her personal experience with DKA and her expert advice on how to recognize, diagnose, and treat DKA. They discuss how DKA can show up in both kids with newly diagnosed diabetes and those already living with the condition. Dr. Buss highlights the importance of paying attention to early warning signs, especially in young kids, where symptoms can be subtle and easy to miss. The conversation also covers how to safely manage DKA, including when to give fluids, how to use insulin carefully, and how to watch for serious complications like cerebral edema (brain swelling). They discuss real-life cases, common mistakes in diagnosing DKA, and how to handle Hyperosmolar Hyperglycemic State (HHS), another dangerous diabetes emergency. Dr. Buss gives helpful tips for monitoring patients, following treatment protocols, and knowing when to call for extra help. Resources Mentioned: CHOP DKA Algorithm: https://pathways.chop.edu/clinical-pathway/diabetes-type1-with-dka-clinical-pathway Cerebral Edema and Muir Criteria:https://achpccg.com/wp-content/uploads/2021/06/tms-picuc-physician-diabetic-ketoacidosis-cerebral-edema-dka-guideline.pdf Sick Day Management: Tips for families on managing diabetes during illness to prevent DKA episodes. 🎧 Listen now on your favorite podcast platform!

In this episode of PEM Chatt, we explore common pediatric orthopedic emergencies with Dr. Chuck Gomez, a pediatric orthopedic surgeon, and John Appel, PA, an experienced emergency medicine provider. We discuss why children's bones differ from adult bones, how this affects fracture patterns, and the best approaches for diagnosis and treatment. Our conversation focuses on upper extremity injuries, including forearm fractures, supracondylar fractures, lateral condyle fractures, nursemaid’s elbow, elbow dislocations, and clavicle fractures. We cover key clinical pearls, such as recognizing subtle fractures that may not appear on initial imaging and ensuring proper splinting techniques to prevent complications. Along the way, Dr. Gomez and John share insights on pain management, including the ongoing discussion around NSAIDs and bone healing, as well as best practices for determining when orthopedic consultation is needed. They emphasize the importance of early recognition of serious fractures, such as Monteggia fractures, and the role of follow-up imaging in cases where occult fractures may become more apparent over time. The episode also highlights practical reduction techniques for nursemaid’s elbow and explains why certain fractures, like clavicle injuries, rarely require surgery despite their dramatic appearance on X-rays. Resources Mentioned: Radiographic Interpretation Guide: Dr. Stewart Braden’s Orthopedics PowerPoint – Includes imaging examples and tips for recognizing key fractures. https://www.scribd.com/document/792597792/Bradin-Orthopedic-Emergencies Montagia Fracture Reference: Ensuring proper radial head alignment on imaging. Pediatric Ortho Follow-Up Recommendations: General guidelines for when to refer and how soon. Coming Next: This was a two-part episode! Stay tuned next month for Part 2, where we’ll discuss lower extremity orthopedic emergencies, including: Femur and tibia fractures Ankle injuries in kids Slipped Capital Femoral Epiphysis (SCFE) Toddler’s fractures And more!

Jennifer Stanfield, PA, with more than 20 years of experience talks about the very important and serious topic of child sexual abuse and sexual assault. Jennifer explains that 1 out of 4 girls and 1 out of 6 boys will face sexual abuse before they turn 18. She shares that most of the time, the person who hurts the child is someone they already know and trust. Jennifer talks about how abusers can trick families and kids (this is called "grooming"), how abuse happens, and why it’s so important for doctors and nurses to know the signs. Jennifer also talks about what happens in the emergency room (ER) when a child comes in for help. She explains how to check the child safely, when to collect evidence, and how doctors work with DCS (Department of Child Services) and the police to keep kids safe. She shares tips on how to talk with parents and how to get help from special places like Children’s Advocacy Centers. The episode also covers what happens when a child or teenager has been sexually assaulted, including how the law works, checking for injuries, preventing infections, and finding counseling to help kids heal. Jen reminds doctors and nurses to take care of themselves too, because helping kids through hard situations can be very tough. She also talks about working together with police, social workers, and local centers to make sure kids are safe and get the care they need. Resources: - National Child Abuse Hotline: 1-800-4-A-CHILD (1-800-422-4453) - Child Advocacy Centers: Local centers that provide forensic interviews and support for child abuse victims.

Kaley Mounce, a nurse practitioner specializing in pediatric neurology, discusses febrile seizures. The episode covers the basics, including their causes, symptoms, and classification into simple and complex categories. Practical advice is offered on assessing and managing children who present with febrile seizures in the emergency room. The discussion provides insights into history taking, physical examination, appropriate diagnostic tests, and strategies for educating and reassuring anxious parents. Complex febrile seizures and febrile status epilepticus are also examined, with recommendations on when to seek a neurology consultation. Personal anecdotes and case studies add valuable context, rounding out the episode with actionable and practical information. Link to references: https://pmc.ncbi.nlm.nih.gov/articles/PMC9396974/ https://www.uptodate.com/contents/clinical-features-and-evaluation-of-febrile-seizures?search=febril...

Dr. Tamarrah Davis, a pediatric emergency medicine physician, joins PEM Chatt to discuss the diagnosis and management of preceptal and orbital cellulitis in children. This episode covers key differences between the two conditions, examination techniques, treatment options, and important considerations for emergency advanced practice providers. Throughout the episode, Dr. Davis shares practical advice on communicating with families about treatment decisions and imaging, as well as pitfalls and pearls for managing these eye infections in the pediatric emergency setting. Great illustrations of the anatomy: https://jamanetwork.com/journals/jama/fullarticle/2758601 Link to References: https://www.uptodate.com/contents/preseptal-cellulitis?search=periorbital%20cellutlis&source=search_result&selectedTitle=1%7E21&usage_type=default&display_rank=1 https://www.uptodate.com/contents/orbital-cellulitis?search=orbital%20cellulitis&source=search_result&selectedTitle=1%7E28&usage_type=default&display_rank=1