19 | Fever Management in Children 3-36 Months: An Evidence-Based Approach with Andrea Perkins PA-C

21 | Submersion Injuries with Dr Sarah Lazarus

21 | Submersion Injuries with Dr. Sarah Lazarus In this episode of PEM CHATT, host Toni Dobson is joined by pediatric emergency physician Dr. Sarah Lazarus to break down the critical topic of pediatric drowning and submersion injuries. Together, they explore real-world clinical scenarios, debunk common myths, and provide practical guidance for both clinicians and caregivers. Drowning remains one of the leading causes of death in children, particularly ages 1–4, and even non-fatal events can result in devastating long-term consequences. This episode emphasizes both clinical management and prevention strategies—highlighting how quickly these events occur and how often they happen despite close supervision.   🔑 Key Takeaways * Drowning is fast and silent * Often occurs in seconds with little to no splashing or noise * Terminology matters * “Dry drowning” and “secondary drowning” are outdated and misleading * Pathophysiology is respiratory * Water aspiration → surfactant washout → impaired gas exchange → hypoxia * Observation is critical * True aspiration events should be monitored for ~6 hours from the time of incident * Imaging isn’t always helpful * Chest X-rays can lead to unnecessary admissions without changing outcomes * Management is symptom-driven * Asymptomatic → observe * Symptomatic → oxygen support, VBG, imaging, admission * Cardiac arrest cases are severe * Focus on oxygenation, ventilation, rewarming, and consider ECMO early * Prevention requires layers * No single strategy (including swim lessons) is sufficient ⚠️ Clinical Pearls * Drowning is an evolving process, not a single moment event * Patients should be observed for 6 hours after the event * Symptoms appearing days later are NOT due to drowning * Pediatric arrests are often respiratory in origin → prioritize ventilation * Antibiotics and steroids are not routinely indicated * Most toddler submersion injuries do NOT require C-spine immobilization 🧠 Myth Busting “Dry drowning” isn’t real. This term originated from outdated medical concepts but is no longer used. If a child had a true submersion injury, symptoms will present within 6 hours—not days later. 🛟 Prevention Insights * Use “arms reach, eyes reach” supervision * Perform a home swim test (can the child swim 2 pool lengths?) * Understand that: * Swim lessons ≠ drowning proof * Life jackets ≠ guaranteed safety * Drowning prevention requires multiple overlapping layers of safety Resources and references: * Brenner’s article: https://pubmed.ncbi.nlm.nih.gov/19255386/ [https://pubmed.ncbi.nlm.nih.gov/19255386/] * CHOA Algorithm: https://www.choa.org/-/media/Files/Childrens/medical-professionals/clinical-practice-guidelines/submersion-event-ed.pdf [https://www.choa.org/-/media/Files/Childrens/medical-professionals/clinical-practice-guidelines/submersion-event-ed.pdf] * NEJM Article: https://www.nejm.org/doi/full/10.1056/NEJMra1013317#figures_media Timeline 00:00 Welcome to PEM CHATT 00:19 Why Drowning Matters 01:12 Meet Dr. Sarah Lazarus 02:14 Bread Pudding is my favorite 03:34 Drowning Terminology 04:38 Who Is Most at Risk 06:08 Silent Drowning Explained 09:15 Systemic Effects Checklist 11:03 Fresh vs Salt vs Cold 11:46 Three Patient Categories 12:36 Case One Asymptomatic Kid 14:12 Avoiding Unneeded X-Rays 16:12 Case Two Symptomatic Infant 18:40 Imaging and Labs Strategy 18:58 When to Skip Antibiotics 20:02 Arrest Scenario Walkthrough 20:30 Resuscitation Priorities And ECMO 21:54 When Resuscitation Is Futile 22:40 C-Spine Immobilization Debate 23:24 Drowning CPR Starts with Breaths 25:29 Injury Prevention Work and Stats 27:14 Layers of Drowning Prevention 30:01 Dry Drowning Myth Busting 33:16 Key Pearls and Closing

20 | Rewind: Preparing for the Return of Vaccine Preventable Illnesses with Dr. Meg Wang

In this “Rewind” episode, Toni sits down with retired pediatrician Dr. Margaret “Meg” Wang, who trained and practiced through the pre-vaccine and early-vaccine eras of pediatrics, including the 1989–1990 measles epidemic in New York City. Together, they walk us through what pediatrics looked like before Hib, pneumococcal, varicella, and rotavirus vaccines and what we might face again as vaccination rates fall and herd immunity wanes. You’ll hear vivid, frontline stories of: * Hib meningitis, occult bacteremia, and epiglottitis in infants and toddlers, when full sepsis workups (blood, urine, CSF, IV antibiotics, 72-hr admissions) were standard for many febrile children through 36 months of age. * “Old-school” periorbital and buccal cellulitis from Hib—bright red with a violaceous hue, toxic kids, high fevers, and automatic LP + admission. * Measles in an actual epidemic: the prodrome with the “three Cs” (cough, coryza, conjunctivitis), Koplik spots, and that classic confluent, head-to-toe rash, plus why measles is not a mild illness. * Varicella beyond the “nuisance rash”: super-itchy multi-stage lesions, serious skin infections, and a child who developed Staph aureus bacteremia and tricuspid valve endocarditis requiring open-heart surgery—all from chickenpox in an unvaccinated child. * Rotavirus winters: the green, watery, diaper-filling diarrhea, relentless fluid losses, metabolic acidosis, hypoglycemia in infants, and frequent admissions—versus the near-disappearance of severe rotavirus disease after the vaccine. Clinically, Toni and Dr. Wang dig into: * How fever protocols for 0–36 month-olds have evolved from routine full sepsis workups to today’s more nuanced approach with viral testing and inflammatory markers like CRP and procalcitonin. * Bedside pattern recognition for epiglottitis (toxic, drooling, tripod positioning, chin thrust, neck extension) and why you never upset these kids or put a tongue blade in their mouth—just get them upright and straight to controlled intubation with anesthesia. * The role of parental gut instinct and why “this is not my kid” should always make you pause and reassess. 🔑 Key Takeaways: * Vaccines didn’t just reduce visit volumes; they completely changed inpatient and ED workflows, procedure rates (LPs!), and long-term morbidity (e.g., deafness after meningitis). * As coverage declines, we won’t just see “more fevers”—we’ll see sicker kids, more invasive procedures, more admissions, and more preventable complications. * Your vaccine counseling today is part of preventing tomorrow’s “Rewind” from becoming reality again. 📌 Call to Action: Hit play, then share this episode with a colleague, resident, or trainee who has never seen these diseases and thinks of measles or chickenpox as “mild.” Their future patients are counting on it. 💉🧠

19 | Fever Management in Children 3-36 Months: An Evidence-Based Approach with Andrea Perkins PA-C

Fever Management in Children 3-36 Months: An Evidence-Based Approach Join host Toni Dobson and guest Andrea Perkins, PA-C, as they dive deep into the evidence-based management of fever in otherwise healthy children aged 3-36 months. This comprehensive episode covers everything from basic fever physiology to algorithmic approaches for both vaccinated and unvaccinated children. Key Topics Covered: Defining fever and understanding the pathophysiology The critical difference between fever and hyperthermia Vaccination status and risk stratification Comprehensive physical exam pearls Evidence-based algorithms for immunized vs. unimmunized children UTI risk assessment and when to obtain urine samples Laboratory workup guidelines based on vaccination status Fever management strategies and parent education Addressing fever phobia in families Resources: UTI Calculator: www.uticalc.com UpToDate management guidelines: UpToDate Link [https://www.uptodate.com/contents/fever-without-a-source-in-children-3-to-36-months-of-age-evaluation-and-management?search=fever%203-] Andrea's algorithm: Link to Algorithm [https://drive.google.com/file/d/17MuJY776EbGIU-G6d1h5uKQXqwY0Jz2T/view?usp=sharing] Next Episode: Dr. Margaret Wang joins us to discuss the return of vaccine-preventable illnesses and how we can prepare. 📺YouTube: https://www.youtube.com/@PEMChatt [https://www.youtube.com/@PEMChatt] 🟢Spotify: https://open.spotify.com/show/6oaYDeq5AXIZGxBvEIxaTs [https://open.spotify.com/show/6oaYDeq5AXIZGxBvEIxaTs] 🍎 Apple Podcasts: https://podcasts.apple.com/us/podcast/pem-chatt/id1806882767 [https://podcasts.apple.com/us/podcast/pem-chatt/id1806882767]

18 | Febrile Neonate with Dr Lindsay McHale

In this episode of PEM CHATT, the focus is on febrile neonates, the first part of a two-part series on pediatric fever management. Host Toni speaks with Dr. Lindsay McHale, a pediatric emergency medicine physician, to discuss how historical protocols for managing febrile neonates have evolved with advances in vaccines, PCR testing, and maternal surveillance. The discussion covers the 2021 AAP guidelines for managing febrile neonates, the essential components of a fever workup, interpretation of test results, and the nuances of decision-making across neonatal age groups. Practical insights on performing lumbar punctures, antibiotic selection, and interpreting potentially confounding results, such as bloody CSF taps, are shared, along with real-life case examples that illustrate the complexities involved. The conversation aims to equip clinicians with an evidence-based approach to improve patient outcomes in various clinical settings. #PEM [https://www.instagram.com/explore/tags/pem/] #NP [https://www.instagram.com/explore/tags/np/] #APP [https://www.instagram.com/explore/tags/app/] #PA [https://www.instagram.com/explore/tags/pa/] #pediatrics [https://www.instagram.com/explore/tags/pediatrics/] #emergencymedicine [https://www.instagram.com/explore/tags/emergencymedicine/] #emergencynursepractitioner [https://www.instagram.com/explore/tags/emergencynursepractitioner/] #fellowship [https://www.instagram.com/explore/tags/fellowship/] #medicaleducation [https://www.instagram.com/explore/tags/medicaleducation/] #podcast [https://www.instagram.com/explore/tags/podcast/] #children [https://www.instagram.com/explore/tags/children/] #nursepractitioner [https://www.instagram.com/explore/tags/nursepractitioner/] #clinicalpharmacists [https://www.instagram.com/explore/tags/clinicalpharmacists/] #febrileneonate #sickbabies #lumbarpuncture 00:00 Introduction to Febrile Neonates 00:57 Historical Management of Febrile Neonates 01:25 Advancements in Medicine and New Guidelines 02:23 Introducing Dr. Lindsay McHale 03:56 Defining Febrile Neonates 04:54 Managing Febrile Neonates in the ER 05:51 Cold Babies and Controversies 07:45 Treating Fever in Neonates 09:06 Inclusion and Exclusion Criteria for Febrile Neonate Protocol 10:27 Why Neonates Are High-Risk 11:40 Code 60: Rapid Response for Febrile Neonates 12:30 Hypothetical Case Study: Febrile Neonate 14:24 Parental Concerns and Communication 19:57 Detailed Workup and Testing 23:27 Antibiotic Choices for Neonates 25:13 Dosing Nuances in Neonatal Antibiotics 26:49 Tips for Performing Lumbar Punctures 30:25 Interpreting Test Results in Neonates 32:46 AAP Sepsis Protocol for Neonates 40:06 Managing Febrile Infants: Case Studies 44:18 Conclusion and Next Episode Preview   LINKS: AAP Guideline https://publications.aap.org/pediatrics/article/148/2/e2021052228/179783/Evaluation-and-Management-of-Well-Appearing?autologincheck=redirected [https://publications.aap.org/pediatrics/article/148/2/e2021052228/179783/Evaluation-and-Management-of-Well-Appearing?autologincheck=redirected] CHOP Algorithm https://www.chop.edu/clinical-pathway/febrile-infant-emergent-evaluation-clinical-pathway [https://www.chop.edu/clinical-pathway/febrile-infant-emergent-evaluation-clinical-pathway] THE MISFITS  https://drive.google.com/file/d/1gpUsQOxMlbuqI-6hBDcZEF5ckpJWhWWb/view?usp=sharing [https://drive.google.com/file/d/1gpUsQOxMlbuqI-6hBDcZEF5ckpJWhWWb/view?usp=sharing]

17 | Essential Medications in the Peds ED with Maggie Raker PharmD and Morgan Padron PharmD

🩺 Essential Medications in Pediatric Emergency Medicine - In-Depth Discussion with Clinical Pharmacists, Mager Raker and Morgan Padron 💊 In this episode of PEM CHATT 🎙️, host Toni Dobson is joined by clinical pharmacists Maggie and Morgan to delve into the key medications used in pediatric emergency medicine 🏥. They cover a wide range of topics, from proper medication dosing and pain control 💉 to antiemetics for nausea 😷, asthma management 🫁, and safe sedation practices 😴. The discussion also includes practical tips for advanced practice providers working in both community hospitals and pediatric-focused facilities 👩‍⚕️👨‍⚕️. Listeners will gain insights into common pitfalls in pediatric prescribing 🚫, the importance of proper dosing ⚖️, and strategies to effectively use medications like Tylenol, ibuprofen, Zofran, morphine, fentanyl, Decadron, and others 💊. The episode aims to enhance the confidence and skills of healthcare providers in caring for young patients 👶👧🧒. The show concludes with a look ahead to the next episode, which will focus on the febrile neonate workup 🍼. 00:00 Introduction to Pediatric Emergency Medicine 00:42 Meet the Hosts and Guests 02:08 Common Pitfalls in Pediatric Prescribing 03:51 Basics of Antipyretics: Tylenol and Ibuprofen 10:03 Anti-Emetic Medications: Zofran and Alternatives 21:19 Pain Control Strategies in Pediatric ER 26:42 Pediatric Dosing and Medication Caps 28:06 Fentanyl: Usage and Administration 29:26 Intranasal Medication Techniques 31:30 Pain Management in Pediatric Emergencies 34:58 Enemas for Constipation Relief 40:00 Asthma Management in Pediatric Patients 48:18 Sedation Techniques in Pediatric Care 52:00 Conclusion and Final Thoughts