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
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.
In this episode, the first of a three part series on asthma, we will cover the diagnostic and treatment strategies that will help you rapidly move patients through your ED. No, of course you don't need the patient's asthma classification, but you DO NEED to understand which patients need more treatment and when it's OK to stop. I will break that all down for you with the aid of the algorithm above. We'll talk in depth about who can go home safely and who should be in the Unit! Download the flow sheet from the link above, put it in your smart-phone so you have it for your next asthma encounter, and follow along. It's going to get musical..
How many times have you seen a square object inserted into a round hole.....of an ear canal??? It's quite a quandary and can be the source of frustration for both you and the patient. You may end up waiting two to three hours just to be able to sedate the little bugger because they have usually just choked down a cheese burger and fries (if your in Britain it may be bangers and mash, Australia a vegemite sandwich, Russia borscht, etc, etc) and then even after you have them sedated, you don't have the right tool to get the foreign body out because the right tool was never created… that is, until now! Thanks to Dr. David DeLemos from the Texas Children's Pediatric Emergency Medicine program, we now have the solution to the round (or square) object in the ear canal. Let me be the first to introduce you to the "Derma-Q." The Derma-Q is a contraption created from the plunger of a small syringe or a Q-tip, which has then been tipped (like a tribal dart) with a minute amount of Dermabond. The Derma-Q provides the perfect rescue technique to get those tough foreign bodies out of almost any orifice. Also making her debut this month on the PEM ED Podcast, my wife, Dr. Holly Sparks will risk life, limb, and my ear canal by getting a cheap piece of plastic jewelry out of my EAC for your viewing pleasure.
Dr. Facilier begged the question..."Are you ready for Transformation Central?" Transformation? My ER runs just fine. What could I need to be ready for or transform my ER into??? Well, there's this little thing standing between you and poop in your underwear; most of us call them pediatric patients. What should scare you is that 30% of the hospitals in the US are not ready and by not ready I mean that they do not have the proper equipment or training necessary to take care of critically ill patients. So I say again, ask yourself, what is the most stressful patient whom you to take care? Is it the little old urosepsis patient that needs an art line, central line and intubation or the neonate that needs the same procedures. OK, the procedures are stressful, but what if you don't have the equipment to to do them. Do you know if your ER stocks a size 1 LMA? Now's the time to figure it out, not once the patient is staring you in the face (probably wide eyed). This month we are fortunate enough to be joined by the esteemed Dr. Marianne Gausche-Hill who is the creator and lead investigator on the Pediatric Readiness Project. We now know from a decade of research that 30% of hospitals in the US are missing the equipment needed to take care of these patients do you work at one of those????
PEDIATRIC READINESS CHECKLIST
Dr. Gauche Hill would like to thank: Dr. Kate Remick, The Federal EMS for Children Program Director Elizabeth Edgerton, National EMS for Children Data Analysis and Resource Center, American College of Emergency Physicians, American Academy of Pediatrics, the Emergency Nurses Association, State of California EMS Authority, and all the EMS for Children’s Coordinators in the US and its territories.
ACEP Policy Statement on the Care of Children in Emergency Departments
Rich Levitan's Yellowstone Critical Care Airway Course - May/June 2014
See you in CABO!!! The new Podcaster's CME conference put on by EB Medicine:
Cabo CME Course - Levitan, Weingart, Mike & Matt, Orman and Sloas
Cabo CME Video
Now I've got your mind palatable to the fact that young thin kids can get cholecystitis too, lets figure out how to weed those kids out from the hundreds of gastroenteritis that you're still going to see each week. On this episode we'll explore which labs and rads get you to the place you want to be.... not just a disposition, but the correct disposition. Dr. Doug Fishman is back to get you on the right track to making the right diagnosis!
You may think that Miley Cyrus' on-stage theatrics was the most shocking thing to happen in 2013, but au contraire mon frère. Hold on tight, because the most outrageous thing you've heard between stanzas of "Auld Lang Syn" is that kid's are getting gallbladder disease. This is especially frequent in the good ole US of A where we have mid-morning cheese burgers for a snack. Shocking I know. In this episode Pediatric Gastroenterologist Dr. Doug Fishman, from the Texas Children's Hospital, is going to go through the In-N-Outs of pediatric cholecystitis. Not that In-N-Out is in anyway responsible for pediatric gallstones...they make a tasty burger....try the double-meat animal style...it's fantastic....
Thanks to Doug Fishman, MD. Director, Gastrointestinal Endoscopy
Texas Children's Hospital
Associate Professor of Pediatrics
Please visit his website devoted to education and treatment of Celiac Disease below