PEM Currents: The Pediatric Emergency Medicine Podcast Brad Sobolewski

This episode features three members of the Pediatric Emergency Care Applied Research Network (PECARN) Adolescent Sexual Health Working Group. PECARN is a network that performs multicenter research related to the emergency care of children. The Adolescent Sexual Health Working Group is focused on researching topics of interest around sexual and reproductive health in the ED. I recently had the pleasure of interviewing three of the study authors and recorded our conversations, then created a podcast episode that hit on some of the highlights of their incredible work. James Gray also helped me put a blog post together that delves into some of the topics in a bit more in depth fashion.







This episode features the contributions of:







Melissa Miller, MDAssociate Professor of PediatricsDivision of Emergency MedicineChildren’s Mercy Hospital Kansas City







Lauren Chernick, MD, MScAssistant Professor of Pediatrics in Emergency MedicineColumbia University Medical Center







Erin Hoehn, MDAssistant Professor of PediatricsDivision of Emergency MedicineChildren’s Hospital of Pittsburgh







Check out the companion blog post at PEMBlog.com







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Key Article







Miller MK, Chernick LS, Goyal MK, et al. A Research Agenda for Emergency Medicine-based Adolescent Sexual and Reproductive Health. Acad Emerg Med. 2019;26(12):1357-1368. doi:10.1111/acem.13809







References







Brown J, Fleming R, Aristzabel J, Gishta R. Does pelvic exam in the emergency department add useful information?. West J Emerg Med. 2011;12(2):208-212.







Farrukh S, Sivitz AB, Onogul B, Patel K, Tejani C. The Additive Value of Pelvic Examinations to History in Predicting Sexually Transmitted Infections for Young Female Patients With Suspected Cervicitis or Pelvic Inflammatory Disease. Ann Emerg Med. 2018 Dec;72(6):703-712.e1. doi: 10.1016/j.annemergmed.2018.05.004. Epub 2018 Jul 2. PMID: 30251627.







Linden JA, Grimmnitz B, Hagopian L, Breaud AH, Langlois BK, Nelson KP, Hart LL, Feldman JA, Brown J, Reid M, Desormeau E, Mitchell PM. Is the Pelvic Examination Still Crucial in Patients Presenting to the Emergency Department With Vaginal Bleeding or Abdominal Pain When an Intrauterine Pregnancy Is Identified on Ultrasonography? A Randomized Controlled Trial. Ann Emerg Med. 2017 Dec;70(6):825-834. doi: 10.1016/j.annemergmed.2017.07.487. Epub 2017 Sep 19. PMID: 28935285.

This episode focuses on high-powered magnet ingestions in children and was a collaboration with Elizabeth Curtis – @egcurtismd and Libby Ireson – @LibbyIreson, two Categorical Pediatrics Residents at Cincinnati Children’s who served as producers and guest hosts. These rare earth magnets were briefly removed from the market because children swallowed them and, when two magnets attracted across opposing loops of bowel, they sustained intestinal injury. Legal machinations led to their reappearance on the market.







This episode is equal parts clinical advice and advocacy in action and will help you discuss these potentially dangerous magnets with families and manage a child in case they swallow one.







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References







CPSC Safety Alert (2007) “Ingested Magnets Can Cause Serious Intestinal Injuries” https://www.cpsc.gov/s3fs-public/5221.pdf   







AAP (2017) “Dangers of Magnetic Toys.” https://www.healthychildren.org/English/safety-prevention/at-home/Pages/Dangers-of-Magnetic-Toys-and-Fake-Piercings.aspx   







Middelberg, L. K., Funk, A. R., Hays, H. L., McKenzie, L. B., Rudolph, B., & Spiller, H. A. (2021). Magnet Injuries in Children: An Analysis of the National Poison Data System From 2008-2019. The Journal of Pediatrics, 0(0). https://doi.org/10.1016/j.jpeds.2021.01.052 







Strickland M, Rosenfield D, Fecteau A. Magnetic foreign body injuries: a large pediatric hospital experience. J Pediatr. 2014 Aug;165(2):332-5. doi: 10.1016/j.jpeds.2014.04.002. Epub 2014 May 16. PMID: 24836391. 







De Roo AC, Thompson MC, Chounthirath T, Xiang H, Cowles NA, Shmuylovskaya L, Smith GA. Rare-earth magnet ingestion-related injuries among children, 2000-2012. Clin Pediatr (Phila). 2013 Nov;52(11):1006-13. doi: 10.1177/0009922813507129. PMID: 24137035. 







Mandhan, P., Alsalihi, M., Mammoo, S., & Ali, M. J. (2014). Troubling toys: rare-earth magnet ingestion in children causing bowel perforations. Case reports in pediatrics, 2014. 







Reeves, P. T., Nylund, C. M., Krishnamurthy, J., Noel, R. A., & Abbas, M. I. (2018). Trends of magnet ingestion in children, an ironic attraction. Journal of pediatric gastroenterology and nutrition, 66(5), e116-e121. 







Spiller, H. (2019) “The Dangers of Magnet Toys.” Nationwide Children’s Hospital www.nationwidechildrens.org/family-resources-education/700childrens/2019/12/magnet-toys

With the warm weather upon us here in the Northern Hemisphere it will soon be time for the pools to open. This episode is therefore incredibly timely, and focuses on the spectrum of submersion injuries and their management. Learn about drowning physiology, when to admit to the hospital, and how to assess the child who went under water unexpectedly but looks fine from this episode’s special co-host and producer, Joe Finney, MD a PGY-5 Pediatric Emergency Medicine and EMS fellow from Washington University in Saint Louis, MO. You can connect will Joe via email at Josephfinney@wustl.edu.







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References







A65. NICU, PICU AND CHRONIC VENTILATION. American Thoracic Society International Conference Meetings Abstracts American Thoracic Society International Conference Meetings Abstracts, www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2016.193.1_MeetingAbstracts.A2198. 







Zuckerman GB, Gregory PM, Santos-Damiani SM. Predictors of Death and Neurologic Impairment in Pediatric Submersion Injuries: The Pediatric Risk of Mortality Score. Arch Pediatr Adolesc Med. 1998;152(2):134–140. doi:10.1001/archpedi.152.2.134







Watson RS, Cummings P, Quan L, Bratton S, Weiss NS. Cervical spine injuries among submersion victims. J Trauma. 2001 Oct;51(4):658-62. doi: 10.1097/00005373-200110000-00006. PMID: 11586155.







Gonzalez-Luis G, Pons M, Cambra FJ, Martin JM, Palomeque A. Use of the Pediatric Risk of Mortality Score as predictor of death and serious neurologic damage in children after submersion. Pediatr Emerg Care. 2001 Dec;17(6):405-9. doi: 10.1097/00006565-200112000-00002. PMID: 11753182.







Noel S. Zuckerbraun, Richard A. Saladino, Pediatric Drowning: Current Management Strategies for Immediate Care, Clinical Pediatric Emergency Medicine, Volume 6, Issue 1, 2005, Pages 49-56, ISSN 1522-8401, https://doi.org/10.1016/j.cpem.2004.12.001. (https://www.sciencedirect.com/science/article/pii/S1522840104000874)







Szpilman D, Morgan PJ. Management for the Drowning Patient. Chest. 2020 Oct 14:S0012-3692(20)34896-0. doi: 10.1016/j.chest.2020.10.007. Epub ahead of print. PMID: 33065105.







Noonan L, Howrey R, Ginsburg CM. Freshwater submersion injuries in children: a retrospective review of seventy-five hospitalized patients. Pediatrics. 1996 Sep;98(3 Pt 1):368-71. PMID: 8784358.







Quan L, Kinder D. Pediatric submersions: prehospital predictors of outcome. Pediatrics. 1992 Dec;90(6):909-13. PMID: 1437433.







Szpilman D. Near-drowning and drowning classification: a proposal to stratify mortality based on the analysis of 1,831 cases. Chest. 1997 Sep;112(3):660-5. doi: 10.1378/chest.112.3.660. PMID: 9315798.







Best RR, Harris BHL, Walsh JL, Manfield T. Pediatric Drowning: A Standard Operating Procedure to Aid the Prehospital Management of Pediatric Cardiac Arrest Resulting From Submersion. Pediatr Emerg Care. 2020 Mar;36(3):143-146. doi: 10.1097/PEC.0000000000001169. PMID: 28486266.







Davey M, Callinan S, Nertney L. Identifying Risk Factors Associated with Fatal Drowning Accidents in the Paediatric Population: A Review of International Evidence. Cureus. 2019 Nov 19;11(11):e6201. doi: 10.7759/cureus.6201. PMID: 31890403; PMCID: PMC6919957.







Habib DM, Tecklenburg FW, Webb SA, Anas NG, Perkin RM.

This is Season 2 of the Toxicology podcast series that Seattle Childrens’ Toxicologist Suzan Mazor, MD and I put together. This three episode season turns its focus to drugs of abuse – continuing with this episode on nicotine toxicity – the final episode of this #ToxTuesdays season.







I am now proud to offer CME through Cincinnati Children’s. To claim visit Cincinnati Children’s Online Courses and search ‘PEM Currents’.







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References







American College of Medical Toxicology: Nicotine







CDC: Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products







Yale medicine – E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI). YaleMedicine.org

This is Season 2 of the Toxicology podcast series that Seattle Childrens’ Toxicologist Suzan Mazor, MD and I put together. It is a joint effort so to speak. This three episode season turns its focus to drugs of abuse – continuing with this episode on marijuana toxicity. So, let’s weed out the bad information, hash out the details, and learn about cannabinoid toxicity in this #ToxTuesdays episode.







I am now proud to offer CME through Cincinnati Children’s. To claim visit Cincinnati Children’s Online Courses and search ‘PEM Currents’.







PEMBlog.com







Follow me on Twitter @PEMTweets







Check out the Facebook page







References







Graham et al. Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome in Adolescents: A Case Series, PEDIATRICS, 2017.







Wang, Pediatric Concerns Due to Expanded Cannabis Use: Unintended Consequences of Legalization, J Med Toxicol. 2017 Mar; 13(1): 99–105.

This is Season 2 of the Toxicology podcast series that Seattle Childrens’ Toxicologist Suzan Mazor, MD and I put together. This three episode season turns its focus to drugs of abuse – beginning with this episode on opioid toxicity. So, slow your breathing, constrict your pupils, and focus in for the return of #ToxTuesdays.







I am now proud to offer CME through Cincinnati Children’s. To claim CME & ABP MOC Part 2, visit Cincinnati Children’s Online Courses and search ‘PEM Currents’.







PEMBlog.com







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References







Allen, et al. Prescription Opioid Exposures Among Children and Adolescents in the United States, PEDIATRICS, 2017.







Boyer, Management of Opioid Analgesic Overdose, NEJM, 2012.







Forti, Opiate Overdose, Pediatrics in Review January 2007, 28 (1) 35-36; DOI: https://doi.org/10.1542/pir.28-1-35.







Matson et al. Opioid Use in Children, J Pediatr Pharmacol Ther. 2019 Jan-Feb; 24(1): 72–75.







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