PEM Chatt

12 | Dysautonomia with Cheryl Fabor and June Bryant, DNP

You can WATCH this episode now on YouTube! https://youtu.be/lH4dYBOVihc
 
In this episode of PEM CHATT, Toni sits down with nurse practitioner, June Bryant, and Cheryl Fabor, Director of Education for the Dysautonomia Project, to discuss the common yet rarely diagnosed condition of dysautonomia. They focus on this impact, symptoms, and treatment options. The conversation sheds light on conditions like POTS that falls under the umbrella of dysautonomia. The discussion includes real-life patient scenarios, diagnostic criteria, and both non-pharmacological and pharmacological treatment options. The episode aims to educate providers and raise awareness of autonomic nervous system disorders, with a focus on understanding patients' experiences and symptoms.
**The details of any patient encounters discussed in this episode have been changed to protect the privacy of patients.
Resources:
https://thedysautonomiaproject.org/
Cheryl Fabor, Director of Education for the Dysautonomia Project
Contact information: cheryl@dysproject.org
Book Referenced in Podcast: https://thedysautonomiaproject.org/get-a-book/
Reach out to Cheryl for a FREE copy!
 
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https://youtu.be/lH4dYBOVihc
 
Timeline:
00:00 Introduction to PEM CHATT
00:26 Understanding dysautonomia
00:55 Case Study: 16 y/o F with syncope
01:32 Meet the Experts: Cheryl Fabor and June Bryant
03:06 What is dysautonomia?
04:30 Common symptoms and misconceptions.
06:31 Prevalence and types of dysautonomia
08:27 Causes and triggers of dysautonomia
10:53 Diagnosing dysautonomia
16:49 Tilt table test explained
22:10 Non-pharm treatments
27:11 Pharmacologic treatments
28:47 Understanding patient symptoms and treatments
31:05 The role of mental health in dysautonomia
32:53 Challenges faced by adolescents with dysautonomia
34:09 Parental involvement in misconceptions
34:50 Lack of education among healthcare providers
34:50 Recovery and management of dysautonomia
39:20 Case study discussed
45:59 Resources and support for dysautonomia
50:02 Conclusion and final thoughts
 
NEXT MONTH: Dr Dan France from Vanderbilt University will be sitting down with Toni to discuss Mental Models and how they shape the way we think and interact with others.

11 | Child Life Specialists in the ED with Madison Matthews, CCLS

In this episode, Toni welcomes Madison Matthews, a Certified Child Life Specialist, to discuss the vital role child life specialists play in pediatric care. Madison explains her background and qualifications, the core principles of child life, and their impact on reducing the need for anesthesia, lowering healthcare costs, and minimizing PTSD and anxiety for young patients. The discussion covers Madison's experiences, including her approach to preparing children for procedures, working with families during traumatic events, and facilitating conversations about serious diagnoses and bereavement. The episode highlights the importance of child life specialists and provides tips for integrating child life techniques in settings without these professionals.
 
00:00 Introduction and Guest Welcome
00:08 Meet Madison Matthews: Certified Child Life Specialist
00:50 Understanding the Role of a Child Life Specialist
02:30 Impact of Child Life Specialists in Healthcare
04:57 Personal Experiences and Challenges
08:33 Theories and Techniques in Child Life
10:28 Practical Applications and Coping Strategies
17:52 Understanding Children's Anxiety in Medical Settings
18:23 Discussing a Brain Tumor Diagnosis with a Child
20:35 Supporting Families During Trauma Situations
22:33 Facilitating Bereavement Conversations
27:59 Emerging Technologies in Child Life
29:11 Implementing Child Life Techniques in Community Settings
34:44 Final Thoughts on Child Life Services
 
NEXT Month: Cheryl Fabor and June Bryant, FNP, from the Dysautonomia Project will be joining us to discuss dysautonomia. This is a condition being seen more commonly in the ED and diagnosis is often delayed for years due to lack of provider recognition. Don't miss this episode!

10 | Pediatric Diabetic Ketoacidosis with Dr. Whitney Buss

In this episode of PEM Chatt, Toni talks with Dr. Whitney Buss about Diabetic Ketoacidosis (DKA) in children. Dr. Buss, a pediatric emergency medicine doctor and type 1 diabetic herself, shares her personal experience with DKA and her expert advice on how to recognize, diagnose, and treat DKA. They discuss how DKA can show up in both kids with newly diagnosed diabetes and those already living with the condition. Dr. Buss highlights the importance of paying attention to early warning signs, especially in young kids, where symptoms can be subtle and easy to miss.
The conversation also covers how to safely manage DKA, including when to give fluids, how to use insulin carefully, and how to watch for serious complications like cerebral edema (brain swelling). They discuss real-life cases, common mistakes in diagnosing DKA, and how to handle Hyperosmolar Hyperglycemic State (HHS), another dangerous diabetes emergency. Dr. Buss gives helpful tips for monitoring patients, following treatment protocols, and knowing when to call for extra help.
Resources Mentioned:
CHOP DKA Algorithm: https://pathways.chop.edu/clinical-pathway/diabetes-type1-with-dka-clinical-pathway
Cerebral Edema and Muir Criteria:https://achpccg.com/wp-content/uploads/2021/06/tms-picuc-physician-diabetic-ketoacidosis-cerebral-edema-dka-guideline.pdf
Sick Day Management: Tips for families on managing diabetes during illness to prevent DKA episodes.
🎧 Listen now on your favorite podcast platform!

09 | Common Orthopedic Emergencies with Dr Chuck Gomez and John Appel, PA (Part 2)

Episode Summary:
In this two-part series, we sit down with Dr. Chuck Gomez, a pediatric orthopedic surgeon, and John Appel, PA, a seasoned emergency medicine provider, to discuss common pediatric orthopedic emergencies. In Part 1, we cover upper extremity injuries, including forearm fractures, supracondylar fractures, lateral condyle fractures, nursemaid’s elbow, elbow dislocations, and clavicle fractures. Dr. Gomez and John share insights on pain management strategies, splinting techniques, and key imaging considerations, ensuring listeners know when to consult orthopedics and how to manage common injuries.
In Part 2, we shift focus to lower extremity orthopedic emergencies, covering conditions such as Slipped Capital Femoral Epiphysis (SCFE), patella dislocations, tibial tubercle fractures, toddler’s fractures, and osteomyelitis/septic arthritis. Dr. Gomez provides guidance on recognizing urgent injuries, including red flags for compartment syndrome and infections, while John shares practical advice for ER-based assessment and initial management. Throughout the discussion, we emphasize when to splint, when to allow weight-bearing, and when orthopedic consultation is critical.
Resources Mentioned:
Radiographic Interpretation Guide: Dr. Stewart Braden’s Orthopedic PowerPoint – Includes imaging examples and fracture patterns. https://www.scribd.com/document/792597792/Bradin-Orthopedic-Emergencies
Ortho References: OrthoBullets for quick reference, UpToDate for evidence-based management, and pediatric orthopedic textbooks for deeper dives.
Pain Control & NSAID Debate: Recommendations on NSAID use in fractures and multimodal pain management approaches.
Septic Joint & Osteomyelitis Workup: Review of inflammatory markers, bedside ultrasound utility, and joint aspiration protocols.
Clinical Pearls for Fracture Management: Guidelines for splinting, weight-bearing restrictions, and follow-up timing.
Next Episode:
Join us next month as we talk with Dr. Whitney Buss about pediatric DKA management. As both a pediatric emergency physician and a Type 1 diabetic, Dr. Buss brings unique insights into how DKA presents in children, key management strategies, and common pitfalls to avoid. Don’t miss this deep dive into a critical pediatric emergency!
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08 | Common Orthopedic Emergencies with Dr Chuck Gomez and John Appel, PA (Part 1)

In this episode of PEM Chatt, we explore common pediatric orthopedic emergencies with Dr. Chuck Gomez, a pediatric orthopedic surgeon, and John Appel, PA, an experienced emergency medicine provider. We discuss why children's bones differ from adult bones, how this affects fracture patterns, and the best approaches for diagnosis and treatment. Our conversation focuses on upper extremity injuries, including forearm fractures, supracondylar fractures, lateral condyle fractures, nursemaid’s elbow, elbow dislocations, and clavicle fractures. We cover key clinical pearls, such as recognizing subtle fractures that may not appear on initial imaging and ensuring proper splinting techniques to prevent complications.
Along the way, Dr. Gomez and John share insights on pain management, including the ongoing discussion around NSAIDs and bone healing, as well as best practices for determining when orthopedic consultation is needed. They emphasize the importance of early recognition of serious fractures, such as Monteggia fractures, and the role of follow-up imaging in cases where occult fractures may become more apparent over time. The episode also highlights practical reduction techniques for nursemaid’s elbow and explains why certain fractures, like clavicle injuries, rarely require surgery despite their dramatic appearance on X-rays.
Resources Mentioned:
Radiographic Interpretation Guide: Dr. Stewart Braden’s Orthopedics PowerPoint – Includes imaging examples and tips for recognizing key fractures. https://www.scribd.com/document/792597792/Bradin-Orthopedic-Emergencies
Montagia Fracture Reference: Ensuring proper radial head alignment on imaging.
Pediatric Ortho Follow-Up Recommendations: General guidelines for when to refer and how soon.
Coming Next:
This was a two-part episode! Stay tuned next month for Part 2, where we’ll discuss lower extremity orthopedic emergencies, including:
Femur and tibia fractures
Ankle injuries in kids
Slipped Capital Femoral Epiphysis (SCFE)
Toddler’s fractures
And more!

07 | Pneumonia with Dr. Beachgem

Toni sits down with the ever-popular Dr. Beachgem, a pediatric emergency medicine physician and social media sensation, to discuss managing pneumonia and other respiratory illnesses in children. They highlight this year’s unique respiratory illness trends, such as a surge in mycoplasma cases and challenges in managing pertussis and flu-related complications.Dr. Beachgem shares practical insights from her experience and emphasizes the art of patient communication, especially with vaccine-hesitant families. The conversation is informative, engaging, and packed with actionable advice for both medical professionals and caregivers. Plus, they explore lighter topics like the joy of curing a nursemaid's elbow and navigating the surreal world of social media fame as a practicing doctor.Resources:Dr. Beachgem on Social MediaFollow Dr. Beachgem for relatable, practical, and insightful pediatric content on [TikTok/Instagram/etc.].Respiratory Illness Management Guidelines
American Academy of Pediatrics (AAP) Guidelines on Pneumonia
Centers for Disease Control and Prevention (CDC) Recommendations on Pertussis
Mycoplasma ResourcesOverview of Mycoplasma in Pediatrics: MedlinePlus
Vaccination GuidanceCDC's Vaccination Schedule: CDC Immunization Schedule

06 | Sexual Abuse with Jennifer Stanfield, PA

Jennifer Stanfield, PA, with more than 20 years of experience talks about the very important and serious topic of child sexual abuse and sexual assault. Jennifer explains that 1 out of 4 girls and 1 out of 6 boys will face sexual abuse before they turn 18. She shares that most of the time, the person who hurts the child is someone they already know and trust. Jennifer talks about how abusers can trick families and kids (this is called "grooming"), how abuse happens, and why it’s so important for doctors and nurses to know the signs.Jennifer also talks about what happens in the emergency room (ER) when a child comes in for help. She explains how to check the child safely, when to collect evidence, and how doctors work with DCS (Department of Child Services) and the police to keep kids safe. She shares tips on how to talk with parents and how to get help from special places like Children’s Advocacy Centers.The episode also covers what happens when a child or teenager has been sexually assaulted, including how the law works, checking for injuries, preventing infections, and finding counseling to help kids heal. Jen reminds doctors and nurses to take care of themselves too, because helping kids through hard situations can be very tough. She also talks about working together with police, social workers, and local centers to make sure kids are safe and get the care they need.Resources:- National Child Abuse Hotline: 1-800-4-A-CHILD (1-800-422-4453)- Child Advocacy Centers: Local centers that provide forensic interviews and support for child abuse victims.

05 | Childhood Physical Abuse with Jennifer Stanfield , PA

Jennifer Stanfield , PA, a pediatric emergency medicine provider with over 21 years of experience, talks about the important topic of childhood physical abuse, focusing on non-accidental trauma (NAT). She explains that there were 3 million cases of child abuse reported in the U.S. in 2022 and shares tools like the TEN4 FACES-P rule to help spot sentinel injuries that could lead to more serious harm. Jen stresses how important it is to check carefully, follow clear steps, and treat every case fairly to keep kids safe. She also talks about how hard this work can be for doctors and advanced practice providers and gives tips to help them stay strong and caring while doing this important job.State of TN NAT Guidelines:https://drive.google.com/file/d/1zoVFx0Vah9magAEwy4uPpGvUWWFkbbcB/view?usp=drive_linkTN Child Abuse Hotline:https://www.tn.gov/dcs/program-areas/child-safety/reporting/child-abuse.htmlTEN4 FACES-P:https://faceitabuse.org/ten4rule/Imaging examples (bucket handle fracture, corner fracture, metaphyseal fractures):https://wikem.org/wiki/Nonaccidental_traumaReferences:https://ct-aap.org/wp-content/uploads/2020/03/Sheets.pdfResources:Books on Trauma and Abuse:A Place Called Home by David AmbroseThe Body Keeps the Score by Bessel van der KolkChild Welfare Information Gateway: Offers resources and support for child abuse prevention. Visit the website.National Child Abuse Hotline: 1-800-4-A-CHILD (1-800-422-4453).

04 | Febrile Seizure with Kaley Mounce, FNP-C

Kaley Mounce, a nurse practitioner specializing in pediatric neurology, discusses febrile seizures. The episode covers the basics, including their causes, symptoms, and classification into simple and complex categories. Practical advice is offered on assessing and managing children who present with febrile seizures in the emergency room. The discussion provides insights into history taking, physical examination, appropriate diagnostic tests, and strategies for educating and reassuring anxious parents. Complex febrile seizures and febrile status epilepticus are also examined, with recommendations on when to seek a neurology consultation. Personal anecdotes and case studies add valuable context, rounding out the episode with actionable and practical information.Link to references: https://pmc.ncbi.nlm.nih.gov/articles/PMC9396974/https://www.uptodate.com/contents/clinical-features-and-evaluation-of-febrile-seizures?search=febril...

03 | Septic Joint with Dr. Jordan Foutch

In this episode of PEM Chatt, Dr. Jordan Foutch discusses the approach to evaluating a limping child in the pediatric emergency department. He emphasizes the importance of considering septic arthritis as a possibility, especially when fever is present. Dr. Foutch outlines the initial workup, including physical examination techniques, lab tests like CBC, inflammatory markers, and imaging studies. He explains the Kocher criteria for risk stratification and discusses the management approach, including when to involve orthopedics and consider joint aspiration or MRI. The conversation also covers various mimickers of septic joint, such as transient synovitis, osteomyelitis, and non-orthopedic conditions. Dr. Foutch provides valuable insights on communicating with parents, making admission decisions, and key pearls for diagnosing and managing limping children in the emergency setting.Link to Kocker Criteria:https://www.mdcalc.com/calc/1817/kocher-criteria-septic-arthritisLink to references:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10974044/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774603/https://www.uptodate.com/contents/evaluation-of-limp-in-children?search=limp child&source=search_result&selectedTitle=1~113&usage_type=default&display_rank=1https://www.uptodate.com/contents/bacterial-arthritis-clinical-features-and-diagnosis-in-infants-and-children?search=septic arthritis child&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1