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In this segment of "Dr. Jay Fisher's List of I Never Want to Miss It" we discuss one of the most challenging diagnosis to make (and manage) in the Pediatric ED. Myocarditis. As always, Dr. Fisher has some great tips and advice. Here are some of the references Jay is referring to in the Podcast ------------------------------------------------------------------ Law YM et al. Diagnosis and Management of Myocarditis in Children.A Scientific Statement From the American Heart Association Circulation. 2021;144:e123–e135.   Freedman SP et al. Pediatric Myocarditis: Emergency Department Clinical Findings and Diagnostic Evaluation. Pediatrics. Volume 120, Number 6, December 2007: 1279-1285.   Genadry A Prediction Rule to Identify Children and Young Adults at Low Risk for Myocarditis. Ped Emerg Care 2025;Volume 41, Number 5, May 2025: 388-394.     Please consider contributing to PEM Rules at https://ko-fi.com/pemrules And check out www.pemrules.com Copyright PEM Rules LLC   DISCLAIMER By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use. This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing "standard of care" in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.

As if being a PEM doctor is not hard (and busy) enough, some of us out there spend countless hours educating the next generation. One of those people is Dr. Emily Rose whose work in PEM education is truly inspiring and is the reason I invited her to the show.

I am very excited to share that on a recent article by FeedSpot Podcasts (a searchable directory and media contact database that catalogs millions of active podcasts across thousands of specialized niches) PEM Rules was ranked number 19 out of the 40 best Pediatric Podcast. T his is a huge achievement (especially considering that there are over 1100 Pediatric Podcasts out there). So thank YOU the listeners and downloaders wherever you are. It is highly appreciated. This would not be possible without YOU.  Here is the Link to the article: https://podcast.feedspot.com/pediatric_podcasts/?feed_id=5404042&_src=f1_featured_email#h5404042

sometimes beyond the subjective complaints there are objective findings, that is when I get considerably more worried about my patients that perhaps there is something serious.

Though I am a Pediatric Emergency Provider, most of the time I don't treat true emergencies. Intensive care is a fairly small portion of what I do. That is why I invited Dr. Matt Goldstein, a PICU doctor from NY to come on the show and discuss the 5 things PICU docs want PEM docs to know…  Low threshold to call and communicate concerns regarding a decompensating patient. Identify high risk intubations Try and get as much history as possible (understanding how busy ED is) Reassess ICU level patients once they are admitted (every hospital is different) The power of airway clearance (especially in children with complex care needs, tracheostomy etc)

Thank you for all of you who have been listening and learning. PEM Rules is (almost) done with summer break and will be back next Monday on August 31. Please tune in. We have great guests and great topics coming up this year.

As in the past, PEM Rules is going to take a summer break to allow me to gather some more material and invite more guests. As always, thank you for the support.  Please consider contributing to PEM Rules at the following link  https://ko-fi.com/pemrules If you are interested in some PEM Rules merchandise, check out the PEM Rules store.  https://www.redbubble.com/shop/ap/164385928

Sometimes the H&P is clouded (for whatever reason) that is a good time to get some objective data (easier said than done) why I think of what other doctors will do and why it is important to plan with the nurse.

The newborn with a new onset (some kind of) metabolic disease is a rare event in the Pediatric ER. Add that to the fact that there are so many different types of diseases with so much basic science to remember and you got a pretty bad situation in your hands. That is why I invited Dr. Austin Larson an Associate Professor of Pediatrics-Clinical Genetics and Metabolism on the show to discuss how we can do a better job identifying and treating those children.

Your demeanor often sets the stage of the encounter which is why it is important to have the opposite one of the patients (usually). How to empower parents to be "doctor like" and why it is important to relate to the caregivers.

Hematological emergencies though uncommon can be a significant problem and is something we should all be familiar with. That is why I asked Dr. Kenneth Bujold (previous intern of mine) to come on the show and tell us how can we do a better job handling true emergencies in Sickle Cell Disease patients.

In this new (not so new anymore) segment of PEM Rules Dr. Jay Fisher, who has been practicing PEM since 1992 came back to discuss an interesting case of something we don't see very often in the Peds ER and NEVER want to miss.

Despite working in a very busy Pediatric Emergency Department, Urological emergencies are not too common and often those patients challenge us. That is why I invited Dr. Jessica Casey whom I sometimes consult from the Pediatric ER to talk about common urological emergencies. Here are two links Jessica recommends us PEM providers   Article on Priapism in children https://pubmed.ncbi.nlm.nih.gov/24135215/ The TWIST score calculator. https://www.mdcalc.com/calc/10440/testicular-workup-ischemia-suspected-torsion-twist   Please consider contributing to PEM Rules at https://ko-fi.com/pemrules And check out www.pemrules.com    Copyright PEM Rules LLC DISCLAIMER By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use. This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing "standard of care" in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.

Good rule for physical exam, why seeing patients in fast track is so important (as a trainee or an attending)  and what I think of blood pressure in pediatric patients.

It is not often that I see a child with possible rheumatologic disease in the pediatric ER. What to ask, what to check for and what labs to order are always important things to think about. That is why I asked Dr. Robert Lowe to come on the show and discuss the management of those patients. Dr. Lowe Advice on Labs to order when suspecting Rheumatological condition: For suspected JIA. Most important to confirm joint swelling on physical exam AND a history of one or more joints being swollen continuously for 6 weeks or longer. Systemic JIA (only 15% of kids with JIA) ESR and CRP are both elevated like you would see with an infection or with inflammatory bowel disease with the added presence of significant joint swelling and daily recurring high fevers (>102F usually) without other symptoms of infection for Systemic JIA. For other systemic autoimmune disease High ESR with normal or near normal CRP can suggest the presence of another systemic autoimmune disease such as SLE D-dimer Ferritin LDH UA with Random protein to Cr ratio Dont order ANA and instead check ONLY the following: ·  Double Stranded DNA (dsDNA) Ab, ·  Smith antibody (not Smooth muscle antibody), ·  Ribonuclear protein Ab (RNP Ab), ·  SSA and SSB Abs (Sjogrens syndrome antibodies)     Please consider contributing to PEM Rules at https://ko-fi.com/pemrules And check out www.pemrules.com  Copyright PEM Rules LLC DISCLAIMER By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use. This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing "standard of care" in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.