PEM Currents: The Pediatric Emergency Medicine Podcast Brad Sobolewski

Laceration repair is one of the quintessential procedures that children undergo in Emergency Departments. Minimizing pain and anxiety for children is a much better idea than just holding them down and getting it done. This episode will teach you all about local anesthetics, when to use anxiolytics and procedural sedations s well as the considerable value of nonpharmacologic intervention – including Child Life Specialists.







This episode is a co-production of the Emergency Medical Services for Children Innovation and Improvement Center whose mission is to minimize morbidity and mortality of acutely ill and injured children across the emergency continuum. We have developed a series of pain focused episodes.







Other Episodes in the Series







The Pediatric EMS Podcast: Ouch-less Pediatrics







EM Pulse: Please Don’t Hurt Me!







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Disclaimer







The Emergency Medical Services for Children Innovation and Improvement Center is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award (U07MC37471) totaling $3M with 0 percent financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov







To learn more about the Emergency Medical Services for Children Innovation and Improvement Center visit https://emscimprovement.center







Email km@emscimprovement.center







Follow on Twitter @EMSCImprovement







References







EMSC IIC Pain Toolkit







Frank et al. How acidic is the lidocaine we are injecting, and how much bicarbonate should we add? Can J Plast Surg. 2012 Summer; 20(2): 71–73. PMCID: PMC3383550







Kennedy RM, Luhmann JD The “ouchless emergency department”. Getting closer: advances in decreasing distress during painful procedures in the emergency department. Pediatr Clin North Am. 1999;46(6):1215. 







Momsen OH et al. Neutralization of lidocaine-adrenaline. A simple method for less painful application of local anesthesia. Ugeskr Laeger. 2000 Aug 14;162(33):4391-4.







Resch K, Schilling C, Borchert BD, Klatzko M, Uden D. Topical anesthesia for pediatric lacerations: a randomized trial of lidocaine-epinephrine-tetracaine solution versus gel. Ann Emerg Med. 1998;32(6):693. 







Sinha M, Christopher NC, Fenn R, Reeves L. Evaluation of nonpharmacologic methods of pain and anxiety management for laceration repair in the pediatric emergency department. Pediatrics. 2006;117(4):1162. 

Update 6/6/22 – there is ongoing work to determine the optimal treatment for meningitis in Lyme between doxy and ceftriaxone. The original episode recording did not make this clear – my apologies. The 2021 IDSA guideline suggests that you could use either agent. This episode was edited to reflect this change.







Lyme disease prevalence continues to rise – especially in places where we didn’t see it before (like Ohio!). this podcast episode focuses on making the diagnosis, the different stages of disease, as well as when to prophylaxis, treat, and how testing works – all in under 15 minutes.







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Helpful Diagnostic Resources







CDC Lyme Disease Resource







CDC Tick ID – which tick bit me?







References







Shapiro ED. Lyme disease. N Engl J Med 2014; 371:684.







Lantos PM, Rumbaugh J, Bockenstedt LK, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis, and Treatment of Lyme Disease. Arthritis Rheumatol 2021; 73:12.







American Academy of Pediatrics. Lyme disease. In: Red Book, 31, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), 2018. p. 515.







Nigrovic LE, Bennett JE, Balamuth F, Levas MN, Chenard RL, Maulden AB, Garro AC; for Pedi Lyme Net. Accuracy of Clinician Suspicion of Lyme Disease in the Emergency Department. Pediatrics. 2017 Dec;140(6):e20171975. doi: 10.1542/peds.2017-1975. PMID: 29175973; PMCID: PMC5703778.

Toxic Shock Syndrome can be hard to recognize and differentiate from clinical entities such as Kawasaki, MIS-C, and DRESS. This brief podcast episode will raise awareness of situations in which TSS can occur and drive home important management pearls – like why you need to add Clindamycin.PEMBlog.com







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References







Gaensbauer JT et al. Epidemiology and Clinical Relevance of Toxic Shock Syndrome in US Children. Pediatr Infect Dis J. 2018 Dec;37(12):1223-1226. PMID: 29601458. 







Javouhey et al. Similarities and Differences Between Staphylococcal and Streptococcal Toxic Shock Syndromes in Children: Results From a 30-Case Cohort. Front Pediatr. 2018 Nov 28;6:360. PMID: 30547021







Rodríguez-Nuñez et al. Streptococcal Toxic Shock Syndrome collaborative group of Spanish Society of Pediatric Intensive Care. Clinical characteristics of children with group A streptococcal toxic shock syndrome admitted to pediatric intensive care units. Eur J Pediatr. 2011 May;170(5):639-44. PMID: 20981441.

Iron ingestions always show up on standardized tests and are definitely one of those “many kids are fine but some aren’t and it’s hard to figure out who’s fine and who isn’t” ingestions. Suzan Mazor from Seattle Children’s helps iron out the details…







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CME and MOC Part II







I am delighted to offer free CME and MOC Part II through Cincinnati Children’s for the entirety of Toxicology Season 3. Just listen to all three episodes and access the CME/MOC portal via this link.







References







Gumber MR, Kute VB, Shah PR, Vanikar AV, Patel HV, Balwani MR, Ghuge PP, Trivedi HL. Successful treatment of severe iron intoxication with gastrointestinal decontamination, deferoxamine, and hemodialysis. Ren Fail. 2013;35(5):729-31. PMID: 23635030.







Chang TP, Rangan C. Iron poisoning: a literature-based review of epidemiology, diagnosis, and management. Pediatr Emerg Care. 2011 Oct;27(10):978-85. PMID: 21975503.

Now this is a frightening ingestion! Calcium channel blockers are hard to manage with refractory shock being one of my main “please don’t let this come to the ED” nightmares. Suzan Mazor breaks it all down and discusses management of this challenging ingestion.







PEMBlog.com







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CME and MOC Part II







I am delighted to offer free CME and MOC Part II through Cincinnati Children’s for the entirety of Toxicology Season 3. Just listen to all three episodes and access the CME/MOC portal via this link.







References







Bartlett, J. W., & Walker, P. L. (2019). Management of Calcium Channel Blocker Toxicity in the Pediatric Patient. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 24(5), 378–389. https://doi.org/10.5863/1551-6776-24.5.378







Chakraborty RK, Hamilton RJ. Calcium Channel Blocker Toxicity. [Updated 2022 Feb 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537147/

There are some scary ingestions out there and I think we’d all agree that bupropion (Wellbutrin) is on the short list of drugs that should make us worry. Learn how to recognize and manage toxicity, especially the neurogenic and cardiac effects of bupropion in the first episode of the third season of Toxicology podcasts from Suzan Mazor and I.







PEMBlog.com







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CME and MOC Part II







I am delighted to offer free CME and MOC Part II through Cincinnati Children’s for the entirety of Toxicology Season 3. Just listen to all three episodes and access the CME/MOC portal via this link.







References







Huecker MR, Smiley A, Saadabadi A. Bupropion. [Updated 2021 Oct 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470212/







Farkas J. Bupropion intoxication. EMCrit. October 1, 2021. Accessed April 11, 2022. https://emcrit.org/ibcc/bupropion/