Pediatric Syncope (DFO ~ Done Fell Out)

Welcome back to the show Dr. Buck Kyle!  Dr. Kyle is a attending pediatric cardiologist at Texas Children’s Hospital and on  this episode we will discuss what causes all those little kids to pass out before they come to your ER and then look so fantastic.  Are they all OK to go home?  Is there anyone in there that’s truly sick and if so how do we identify that subset?  Sit back, hold on tight, and try not to DFO (done fell out) because it’s going to be fast, fun, and may leave you a little mareado….

Long QT Medication Website
Long QT Medication Website Screen Shot 2014-12-21 at 4.27.14 PM.png


The Five Canons of Levitan – Difficult Airway Part 3

Canon - a general law, rule, principle, or criterion by which something is judged

No one has changed the face of how we approach difficult airway more than Rich Levitan, MD.  In this episode I review five of Rich's most important contributions to how we approach emergent intubations.  These are techniques you can take to the department tomorrow to improve your view, increase your success, and save your patient's life! 

Click here to follow Dr. Levitan on twitter.

Click here to follow Dr. Levitan on twitter.

Ear to sternal notch positioning will not only improve your view, but save your backside and possibly your patient's life!
Ear to sternal notch positioning will not only improve your view, but save your backside and possibly your patient's life! Levitan's best bougie techniques (includes Shaka, Kiwi and Ducanto)!

Levitan's best bougie techniques (includes Shaka, Kiwi and Ducanto)!

Child Abuse

It is hard to put into words or even imagine the concept of someone intentionally hurting a child, but it happens more frequently than we'd like to believe.  In this episode, I had the privilege of discussing some of the cornerstone exam findings and history flags for occult abuse with Marci Donaruma-Kowh, MD a child abuse expert from the Baylor College of Medicine ~ Texas Children's Hospital.  This episode will change the lens you view your pediatric patients through; even with those who have what appears to be the most mundane of injuries.  Unfortunately, abuse is not always overt and Dr. Donaruma is an expert in identifying the subtleties of this diagnosis, nailing the perpetrator, and making sure they go away for a long-long time...

If you know of a child that is being abused call the police now.  If you would like to refer a case and you are in the Houston area please click here: Children's Assessment Center.

Asthma and the Vent

                                                              TOP  =  AUTO PEEP        BOTTOM  =  NORMAL FLOW

                                                              TOP  =  AUTO PEEP        BOTTOM  =  NORMAL FLOW

Set the Vent in SIMV at 7cc/kg and an I:E ratio of 1:4/1:5 and check a blood gas!
— Andrew Sloas, DO, RDMS, FAAEM

Wow!  We've made it to the end of three episodes on asthma.  We've covered everything from diagnosis to treatment and everything in between.  We now know how to best educate our patients to empower them to treat their disease at home and prevent recitivism! 

Tune in this episode for the specifics on how to use a Peak Flow Meter, Bi-Pap, EtCO2 and of course how to set-up the ventilator in a way to maximize support and minimize chances of injury in your asthmatics. 

EM Crit - Infamous Awake Sedated Video

EM Crit - Dominating the Vent Part 1

EM Crit - Dominating the Vent Part 2


Asthma Andrews Style – What’s the best oral steroid you ask?


What's the best oral steroid to treat acute asthma exacerbations you may ask? Well, we're here to answer that for you.  Please welcome Dr. Annie Andrews, MD, MSCR who has written all the articles you will find listed below on just that subject.  In this podcast we will prove that dexamethasone is not only the most cost effective steroid to prescribe in asthma exacerbations, decreases recidivism, and has the best compliance rates, but it tastes great too!

Andrews AL, Simpson AN. Dexamethasone may be a viable alternative to
prednisone/prednisolone for the treatment of acute asthma exacerbation in the
paediatric emergency department. Evid Based Med. 2014 Jun 10. pii:
ebmed-2014-110006. doi: 10.1136/eb-2014-110006. [Epub ahead of print] PubMed
PMID: 24919976.

Andrews AL, Wong KA, Heine D, Scott Russell W. A cost-effectiveness analysis
of dexamethasone versus prednisone in pediatric acute asthma exacerbations. Acad
Emerg Med. 2012 Aug;19(8):943-8. doi: 10.1111/j.1553-2712.2012.01418.x. Epub 2012
Jul 31. PubMed PMID: 22849379.

Andrews AL, Teufel RJ, 2nd, Basco WT, Jr., Simpson KN. A Cost-Effectiveness Analysis of Inhaled Corticosteroid Delivery for Children with Asthma in the Emergency Department. Journal of Pediatrics. 2012 Nov;161(5):903-907

Keeney GE, Gray MP, Morrison AK, Levas MN, Kessler EA, Hill GD, Gorelick MH, Jackson JL. Dexamethasone for acute asthma exacerbations in children: a meta-analysis. Pediatrics. 2014 Mar;133(3):493-9. doi: 10.1542/peds.2013-2273. Epub 2014 Feb 10. Review. PubMed PMID: 24515516; PubMed Central PMCID: PMC3934336.

Podcast 25 ~ Asthma and Steroids