4 episodes

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.,

    • Medicine
    • 4.6 • 44 Ratings

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.

    Failure to Thrive, Part 1

    Failure to Thrive, Part 1

    This free iTunes segment is just one tiny snippet of the fully-loaded 3-hour monthly Peds RAP show. Earn CME on your commute while getting the latest practice-changing peds information: journal article breakdowns, evidence-based topic reviews, critical guideline updates, conversations with experts, and so much more. Sign up for the full show at hippoed.com/PEDSRAPPOD.
    Michelle Thompson, MD, and Solomon Behar, MD discuss the diagnosis of and evaluation of a child with failure to thrive.
    Pearls:
    Failure to thrive is a weight for age that is less than the third percentile, a weight for height that is below the fifth percentile, or a weight that decreases two or more major percentile lines. There are generally three reasons kids fail to thrive; they do not take enough calories in, they take enough calories in but they do not properly absorb the calories, or their metabolic needs outweigh the amount of calories that they are taking in. The majority of the workup is in the history and physical exam.  
    What is failure to thrive (FTT)? Failure to thrive is the inavailability or unavailability of usable calories. Usually, it is in a child who is less than 2 years of age who meets certain criteria. The three most common criteria used clinically are: 1) a weight for age that is less than the third percentile, 2) a weight for height that is below the fifth percentile, and 3) a weight that decreases two or more major percentile lines. When babies are first born, they can be large and then at the two or four month visit they are crossing a number of growth percentage lines. How does this type of weight loss play into it? There is wiggle room for adjustment for large babies, preemie babies and babies with intrauterine growth restriction or IUGR.  When we talk about an initially large baby in the first months of life 0-3,  weight is generally more representative of the placental health and pregnancy factors. For a premature baby who is really tiny and starts out in the third percentile, how do you make the diagnosis of FTT?  We continue to plot preemie infants on a preemie growth chart until about two years of age.  You have to look at the velocity of the child’s weight and then take into consideration the height as well.  A child who is running below the third percentile consistently, but is tracking along a line below the third percentile, i.e. normal growth velocity, and the weight for height is demonstrating that he is on the normal curve, then genetically the baby may be programmed to be that way. That is not necessarily going to be defined as FTT. What about a child with a syndrome like Down syndrome who has their own growth curve? Can you do the same thing for them? Plotting along the available growth curves for those special populations when we have growth curves available is very important. To have a diagnosis of failure to thrive, you really do need to see the weight falling off the curve and dropping through percentiles. These days most children who have failure to thrive tend to have some combination of an underlying physical or developmental issue combined with environmental or social factors. Why do kids fail to thrive? There are generally three reasons kids fail to thrive. 1) The children are not getting enough calories 2)The children are getting enough calories, but they are not able to absorb the calories 3) The children have excess caloric expenditure because their metabolic needs outweigh the amount of calories that they are taking in.  This increased metabolic demand can be seen in  chronic hypoxemia, chronic lung disease, and congenital heart disease Let’s say you have a patient who comes to your clinic and he has dropped a few percentiles on his growth chart. Where do we start? Try to identify any patterns to the way the child is growing or not growing.  Look at the timing of the concern in the

    • 19 min
    Bilious Emesis in Neonates

    Bilious Emesis in Neonates

    This free iTunes segment is just one tiny snippet of the fully-loaded 3-hour monthly Peds RAP show. Earn CME on your commute while getting the latest practice-changing peds information: journal article breakdowns, evidence-based topic reviews, critical guideline updates, conversations with experts, and so much more. Sign up for the full show at hippoed.com/PEDSRAPPOD.
    Sol Behar, MD, and Jason Woods, MD discuss the evaluation and management of bilious emesis in a neonate. 
    Bilious emesis in an infant should be treated as an emergency because this is often a symptom of obstruction due to intestinal atresia or midgut volvulus. Causes of intestinal obstruction that present during the neonatal period include: Malrotation with or without volvulus Intestinal atresia Hirschsprung disease Intussusception (rare in the neonatal period) Necrotizing enterocolitis  Malrotation with volvulus. In this condition, the cecum is abnormally positioned in the right upper quadrant and this abnormal positioning predisposes the intestine to twist on its mesentery resulting in volvulus. This causes acute small bowel obstruction and ischemia.  An upper GI, the gold standard for diagnosing or evaluating malrotation, classically shows a duodenum with a "corkscrew" appearance. Intestinal atresia. This is a term used to describe a complete blockage or obstruction anywhere in the intestine. Approximately 30% of infants with duodenal atresia have a chromosomal anomaly, most typically Down syndrome. The "double bubble" sign is caused by dilation of the stomach and proximal duodenum and strongly suggests duodenal atresia Hirschsprung disease. This is a disorder of the motor innervation of the distal intestine that leads to a functional obstruction. In Hirschsprung, the nerves that allow the relaxation of the smooth muscle within the intestine wall are missing, so the area that is affected is constricted.  
    A contrast enema can support the diagnosis of Hirschsprung disease. It will often show the presence of a “transition zone” which represents the change from the normal caliber rectum to the dilated colon proximal to the aganglionic region.  
    For younger kids who have not had time to develop the “transition zone”, the rectosigmoid index, the ratio between the diameter of the rectum and the sigmoid colon, is typically >1 in normal children  
    Necrotizing enterocolitis. This is a condition characterized by bowel necrosis with associated severe inflammation, bacterial invasion, and dissection of gas into the bowel wall. Pneumatosis intestinalis, a hallmark of NEC, appears as bubbles of gas in the bowel wall. Meconium ileus is caused by the obstruction of the small intestines with inspissated meconium. Approximately 10% of patients with CF present with meconium ileus.

    • 23 min
    Cephalosporins - Part One

    Cephalosporins - Part One

    This free iTunes segment is just one tiny snippet of the fully-loaded 3-hour monthly Peds RAP show. Earn CME on your commute while getting the latest practice-changing peds information: journal article breakdowns, evidence-based topic reviews, critical guideline updates, conversations with experts, and so much more. Sign up for the full show at hippoed.com/PEDSRAPPOD.
    Pediatric ID specialist Michael Neely, MD, and Michael Cosimini, MD discuss how cephalosporins work and which bugs they do and do not kill.
    Pearls:
    In general, cephalosporins do not cover anaerobes, enterococcus, listeria and MRSA. Oral cephalosporins are generally not first line in pediatrics.  Some exceptions include the treatment of UTIs and some skin and soft tissue infections; group A strep and sinopulmonary infections in penicillin allergic patients are other common indications. 1st generation cephalosporins do have gram positive coverage, but do not work well against strep pneumo, MRSA, enterococcus. They do cover some enteric gram negative bacteria, the “PECK” organisms.  
    What are cephalosporin antibiotics and how do they compare to penicillins?  Chemically, both penicillins and cephalosporins are beta-lactam antibiotics, with the beta-lactam portion responsible for bacterial killing.  The chemical portions off the beta-lactam ring make the antibiotics different. Beta-lactam antibiotics work by binding to the penicillin-binding protein on the bacterial cell wall.  These proteins have structural functions that maintain the integrity of the bacterial cell wall and therefore, when these antibiotics bind, the penicillin-binding protein is disrupted, the cell wall falls apart and the bacterial dies.       How do you keep a straight spectrum of activity for antibiotics?  To help with this, think of bacteria into big categories: gram-positive, gram-negative and “other”. Gram-positive bacteria include: Staph aureus (MSSA, MRSA), Streptococcus (Group A Strep, Group B Strep, Strep pyogenes, Strep viridans), Enterococcus, Pneumococcus, Listeria Gram-negative bacteria are a much bigger group and can be divided into: Respiratory gram-negatives include Moraxella, Haemophilus, Meningococcus Enteric gram-negatives include the “PECK” bacteria: Proteus, E.coli, Klebsiella What bacteria do cephalosporins not cover?  In general, cephalosporins do not cover anaerobic bacteria, enterococcus, listeria and MRSA.  There are a few exceptions to this rule. Cefoxitin (a second generation cephalosporin), for example, does have anaerobic coverage.  It is commonly used in the treatment of PID as it covers enteric anaerobes and Neisseria gonorrhea. There is a 5th generation cephalosporin that does cover MRSA (discussed later). Are cephalosporins well absorbed?  Generally speaking, cephalosporins in oral formulations are not as well absorbed as penicillins and are more difficult to get where they need to go outside the urinary tract. Also, generally speaking, no beta-lactam really gets into the spinal fluid in very high concentrations; all of them do have better penetration when there is inflammation.  Practically, remember that the penetration into the CSF between ampicillin and ceftriaxone is negligible. What bacteria do first generation cephalosporins cover?  Although the classic teaching is that cephalosporins are good for gram-positive coverage (staph and strep), this is not a hard and fast rule.  As stated, enterococcus is not covered by any cephalosporin and MRSA is not covered by most cephalosporins.  First generation cephalosporins are also good for coverage of the “PECK” enteric gram negative bacteria, but not good for coverage of other gram negative bacteria.  These organisms tend to cause UTIs and therefore, first generation cephalosporins (for example, cephalexin) are frequently used for UTI treatment. Of

    • 16 min
    Herpes Simplex - Part One

    Herpes Simplex - Part One

    This free iTunes segment is just one tiny snippet of the fully-loaded 3-hour monthly Peds RAP show. Earn CME on your commute while getting the latest practice-changing peds information: journal article breakdowns, evidence-based topic reviews, critical guideline updates, conversations with experts, and so much more. Sign up for the full show at hippoed.com/PEDSRAPPOD.
    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.
    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 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

    • 27 min

Customer Reviews

4.6 out of 5
44 Ratings

44 Ratings

Sjhdhsjsj ,

The best one out there

There are a lot of podcasts around but this is the original and the strongest out there. Do you think education has to be boring? Nope.

Top Podcasts In Medicine

Listeners Also Subscribed To