22エピソード

Your work is hard; staying current shouldn’t be. Keep your practice ahead of the curve with entertaining, engaging and concise pediatric topics from world-class educators.

This iTunes segment is just one monthly free segment of the full Peds RAP show. Get 3 hours of fresh podcast episodes per month and 42 AMA PRA Category 1 credit(s)™ per year when you sign up for the full podcast at hippoed.com.

Don’t forget to download the Peds RAP app in the app store for even more streamlined listening.

Peds RAP Hippo Education LLC.,

    • 医学

Your work is hard; staying current shouldn’t be. Keep your practice ahead of the curve with entertaining, engaging and concise pediatric topics from world-class educators.

This iTunes segment is just one monthly free segment of the full Peds RAP show. Get 3 hours of fresh podcast episodes per month and 42 AMA PRA Category 1 credit(s)™ per year when you sign up for the full podcast at hippoed.com.

Don’t forget to download the Peds RAP app in the app store for even more streamlined listening.

    Herpes Simplex - Part One

    Herpes Simplex - Part One

    Andi Marmor, MD and Lisa Patel, MD review the cutaneous and systemic manifestations of HSV1, when testing is indicated, potential co-infections, and discuss management strategies depending on presentation.
    For more incredible segments like this, subscribe to PC:RAP today. You'll never miss a moment of the program and earn 42 hours of CME per year. 

    Transmission of HSV-1 occurs when someone with no prior infection comes in contact with herpetic lesions, mucosal secretions, or skin lesions that contain HSV-1. Transmission can occur when infected body secretions come into contact with a break in the skin. 
    In the acute phase of the infection, the herpes virus replicates at the site of contact. From there, the virus enters the sensory nerve and travels to the ganglion. Typically it establishes latency in the trigeminal nerve ganglion (or sacral ganglion depending on the initial site of infection) and it can then reactivate in any of the branches of that nerve throughout life.
    HSV PCR and viral culture are the two tests used to confirm the diagnosis of  HSV.
    A viral culture can distinguish between HSV-1 and HSV-2.
    HSV PCR is typically faster and more sensitive than a viral culture. 
    Serologic testing has a limited role in acute infection but can be helpful in establishing prior infection in someone who is, for example, undergoing an organ transplant where antiviral prophylaxis might be needed. 
    Primary HSV-1 oral infection usually presents as gingivostomatitis in children.High fevers and malaise are the typical prodromal symptoms which are then followed by the development of painful vesicular lesions. Lesions can affect the entire gingiva and also often involves the buccal mucosa, tongue, and the floor of the mouth. There may also be some sores on the outside of the mouth and around the lips.
    In coxsackievirus, the majority of the lesions are in the posterior oropharynx whereas with HSV gingivostomatitis, the majority are in the anterior mouth. The distribution of the lesions can help distinguish between the two viruses. 
    Children with gingivostomatitis may require hospitalization for pain control and/or dehydration. 
    For pain management, Andi advises using around the clock NSAIDs and does not recommend using Magic mouthwash.
    Magic mouthwash is typically a 1:1:1: ratio combination of viscous lidocaine, diphenhydramine, magnesium hydroxide (or aluminum hydroxide) mixed with a flavored syrup. Andi does not recommend because 1) viscous lidocaine is well absorbed through the oral mucosa and can quickly reach a toxic level in young kids and 2) there is not much evidence showing that improves pain control or that helps kids hydrate. 
    Honey was shown in a recent randomized control trial to both improve pain control and less than the time to healing. 
    Acyclovir, in addition to supportive care measures, is recommended in children with severe symptoms and who present within 72-96 hours of disease onset. A Cochrane review from 2008 showed that it decreased the time to healing and lessened the amount of pain medicine needed. The typical dosing is 15 mg/kg by mouth (maximum single dose 200 mg) five times per day.
    Herpetic whitlow (see image below, photo credit: Solomon Behar)  is an infection of the soft tissue of the finger caused by HSV. It is usually localized to the nailfold. These lesions are initially clear-yellow vesicles that then coalesce into a larger blister. Herpetic whitlow  is often confused with a bacterial infection like paronychia or a pulp abscess. 
    Unlike a paronychia, the area filled with pus is not tense in the setting of herpetic whitlow.
    Treatment in most cases is doing nothing. The time that this takes to resolve is two to three weeks. Consider treatment with acyclovir if it is on multiple digits, if the child is systemically ill, or if

    • 28分
    Bonus Short - Novel Coronavirus

    Bonus Short - Novel Coronavirus

    In this Hippo Education Short, Infectious Diseases specialist Dr. Devang Patel sits down with our own Dr. Neda Frayha to discuss what we know so far about the new 2019-n-CoV coronavirus outbreak and what front-line clinicians can do if we suspect a patient of ours might have this viral illness. 

    References:
    Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med, 24 Jan 2020. DOI: 10.1056/NEJMoa2001017. 
    Munster VJ, Koopmans M, van Doremalen M, et al. A novel coronavirus emerging in China - key questions for impact assessment. N Engl J Med, 24 Jan 2020. DOI: 10.1056/NEJMp2000929
    Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 24 Jan 2020. https://doi.org/10.1016/ S0140-6736(20)30183-5   
    Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet, 24 Jan 2020. https://doi.org/10.1016/S0140-6736(20)30154-9
    Phan LT, Nguyen TV, Luong QC, et al. Importation and human-to-human transmission of a novel coronavirus in Vietnam. N Engl J Med, 28 Jan 2020. DOI: 10.1056/NEJMc2001272
    Wuhan Coronavirus - 2019-n-CoV. Infectious Diseases Society of America. https://www.idsociety.org/public-health/wuhan-coronavirus/. Accessed 29 Jan 2020
    2019 Novel Coronavirus (2019-n-CoV), Wuhan, China. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/summary.html. Accessed 29 Jan 2020.
    Update and Interim Guidance on Outbreak of 2019 Novel Coronavirus (2019-n-CoV) in Wuhan, China. Centers for Disease Control and Prevention. https://emergency.cdc.gov/han/han00426.asp. Accessed 29 Jan 2020.
     
    Resource:
    Centers for Disease Control and Prevention 2019-n-CoV PUI Case Investigation Form: https://www.cdc.gov/coronavirus/2019-ncov/downloads/pui-form.pdfpdf icon

    • 18分
    Group A Streptococcal (GAS) Pharyngitis | Part 1

    Group A Streptococcal (GAS) Pharyngitis | Part 1

    Andi Marmor, MD and Sol Behar, MD review clinical features, complications, and latest treatment options of strep pharyngitis.

    GAS as a cause of pharyngitis is most commonly observed in children 5–15 years of age.
    Diagnostic studies for GAS pharyngitis are not recommended for children under 3  because acute rheumatic fever is rare in children
     
    Ed’s note: the IDSA says in this situation you can consider testing a 3 year old. If a child is
     
    To hear Part 2 of this conversation click the link below to subscribe today!
    There is so much more to PedsRAP each month. For more incredible education and 42 hours of CME CLICK HERE!  

    • 20分
    Opioids - Part One

    Opioids - Part One

    Rita Agarwal, MD and Lisa Patel, MD discuss safe prescribing practices in the age of the opioid epidemic.  Rita outlines when opioids are appropriate for pain management versus when to consider other medications or modalities.  She discusses the PILLS pneumonic to counsel families on storage, safety, and disposal of these medications. And she discusses how to manage patients with difficult to treat pain syndromes.
    Click here and subscribe to hear Part 2 and get 3.5 hours of CME each month CLICK HERE! 

    • 23分
    Peripartum practices

    Peripartum practices

    Sol Behar, MD and CHOP NICU doc Joanna Parga-Belinkie, MD review the evidence behind some of the peripartum practices that happen in the delivery room and in the immediate aftermath.
    There is so much more to PedsRAP each month. For more incredible education and 42 hours of CME CLICK HERE!  

    • 27分
    High Flow Nasal Cannula in Bronchiolitis | Part 1

    High Flow Nasal Cannula in Bronchiolitis | Part 1

    High flow nasal cannula is being used with increasing frequency on pediatric ward floors for children with bronchiolitis.  Lisa Patel, MD and Andi Marmor, MD discuss the evidence on its use to reduce escalation of care and decrease length of stay. They also discuss how to start, titrate and wean settings on HFNC.
     
    There is so much more to PedsRAP each month. To listen to Part 2 of this incredible segment and even more incredible education along with 42 hours of CME CLICK HERE!  

    • 14分

医学のトップPodcast

他のリスナーはこちらのサブスクリプションにも登録しています