The goal of our long (and exhausting) training is to find the ultimate job. Here are some tips from Dr. Rick Saladino (my fellowship mentor and the inspiration behind PEM Rules) on the process.

What is the “best way” to take history, talking about patients expectations and what you must do before calling your consultants.

Children with Neurological complaints represent a significant portion of what we see in the Peds ED. From Status Epilepticus to febrile seizures to the child who (maybe) had a seizure at home. This is a discussion I had with Dr. Amy Goldstein, a Pediatric Neurologist at CHOP.

Please consider contributing to PEM Rules at

https://ko-fi.com/pemrules

And check out www.pemrules.com

Copyright PEM Rules LLC

DISCLAIMER

By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.

This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.

There are many “unanswered” questions in Pediatric EM where the scientific literature does not have a good, definitive answer. Whether to use or not to use steroids in anaphylaxis is one of them. Sophia Wang (our PEM fellow from previous episodes) looked into it.

Here are some of the articles Sophia used in her research

Alqurashi W, Ellis AK. Do Corticosteroids Prevent Biphasic Anaphylaxis?. J Allergy Clin Immunol Pract. 2017;5(5):1194-1205. doi:10.1016/j.jaip.2017.05.022

Gaffney LK, Porter J, Gerling M, Schneider LC, Stack AM, Shah D, Michelson KA. Safely Reducing Hospitalizations for Anaphylaxis in Children Through an Evidence-Based Guideline. Pediatrics. 2022 Feb 1;149(2):e2020045831. doi: 10.1542/peds.2020-045831. PMID: 35059724; PMCID: PMC9250079.

Lieberman P, Nicklas RA, Randolph C, et al. Anaphylaxis--a practice parameter update 2015. Ann Allergy Asthma Immunol. 2015;115(5):341-384. doi:10.1016/j.anai.2015.07.019

Michelson KA, Dribin TE, Vyles D, Neuman MI. Trends in emergency care for anaphylaxis. J Allergy Clin Immunol Pract. 2020;8(2):767-768.e2. doi:10.1016/j.jaip.2019.07.018

Shaker MS, Wallace DV, Golden DBK, et al. Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol. 2020;145(4):1082-1123. doi:10.1016/j.jaci.2020.01.017

Please consider contributing to PEM Rules at

https://ko-fi.com/pemrules

And check out www.pemrules.com

Copyright PEM Rules LLC

DISCLAIMER

By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use.

This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.

Sometimes it is good to give your patients (or parents) some options regarding their care (some people call it shared decision making). How a short conversation can help you better understand your patients and their needs.

After many months of work and some requests I am excited to open my online PEM Rules Store where listeners can order some fun PEM Rules merchandise. Please click the link below to check out the store and maybe purchase a T-shirt, a hat or whatever product you like.

Thank you for all the support, the downloads, comments and requests.

Yaron Ivan

PEM Rules Online Store.

https://www.redbubble.com/shop/ap/164385928

www.pemrules.com

Every once in a while I meet a physician who does a great job “taking care of himself / herself”. He or she are engaged in multipule activities or hobbies and don’t seem to be suffering “burnout”. Listen to my discussion with Dr. Snow and his advice on how to achieve wellness.

Having a goal before you see the patient is crucial and it should not be to find a diagnosis. It is ok to fail but not so ok not to try and what about the patient's mental status?