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PED-EM-L  February 2018

PED-EM-L February 2018

Subject:

Re: PED-EM-L Digest - 15 Feb 2018 to 16 Feb 2018 (#2018-39)

From:

Robert Finkelstein <[log in to unmask]>

Reply-To:

Robert Finkelstein <[log in to unmask]>

Date:

Sun, 18 Feb 2018 17:09:24 +0000

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (1 lines)

Other countries have the same level of mental illness as the United States, but not nearly the number of gun deaths. The mental health issue is important but access to weapons that can kill a large number of people in seconds allows the results we see. In addition, access to guns plays  a huge role in suicides since many who attempt suicide and do not succeed will get help and not attempt again. However, access to a gun makes it much more likely that the first attempt will result in death.

Robert Finkelstein

> On Feb 18, 2018, at 8:42 AM, Mick Work <[log in to unmask]> wrote:
> 
> I respect the need for debate around guns.   However, I think we are remiss as pediatric emergency physicians to not raise a deeper discussion around the mental illness crisis.  
> 
> We all see kids who meet this persons profile across the country. We see disturbing mental illness and the many factors (including social media, broken families, child abuse) that lead a child to buy a gun to do harm.  Or if not gun an explosive device etc.. 
> 
> We see kids who are socially isolated and warning signs ignored.  Anyone else concerned that the kids we see with mental illness are recognized by schools or pediatric visit screening more often than by their own parents, friends or neighbors.  
> 
> This persons desire to be a “school shooter” should raise attention around how the media covers these events.  The fame brought to these shooters should be called into question.  Are we fostering this copycat mentality?  
> 
> The lack of respect for human life should call us to question more than the how but why.   
> 
> A focus only on guns and gun laws is remiss to the bigger picture in my opinion and experience.  
> 
> Mick 
> 
> 
> 
>> On Feb 17, 2018, at 12:01 AM, PED-EM-L automatic digest system <[log in to unmask]> wrote:
>> 
>> There are 4 messages totaling 391 lines in this issue.
>> 
>> Topics of the day:
>> 
>> 1. Peds EM talk (2)
>> 2. Bacterial meningitis
>> 3. The shooting in Florida
>> 
>> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
>> The URL for the PED-EM-L Web Page is:
>>                http://listserv.brown.edu/ped-em-l.html
>> 
>> ----------------------------------------------------------------------
>> 
>> Date:    Fri, 16 Feb 2018 11:50:44 -0500
>> From:    Purva Grover <[log in to unmask]>
>> Subject: Re: Peds EM talk
>> 
>> Thanks all for your help on this.
>> Best
>> Purva
>> 
>> Purva Grover , MD
>> Medical Director
>> Pediatric Emergency Department
>> Cleveland Clinic Health System
>> Email- [log in to unmask] <[log in to unmask]>g
>> 
>>> On Thu, Feb 15, 2018 at 2:18 PM, <[log in to unmask]> wrote:
>>> 
>>> Hi All
>>> I am giving an hour ppt to new PAs on Peds Emergencies. Clearly can not
>>> cover ALL or even most. Any thoughts / talks / power points- you could
>>> share would be appreciated.
>>> Thanks
>>> Purva
>>> 
>>> Sent from my mobile device
>> 
>> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
>> The URL for the PED-EM-L Web Page is:
>>                http://listserv.brown.edu/ped-em-l.html
>> 
>> ------------------------------
>> 
>> Date:    Fri, 16 Feb 2018 14:34:20 +0000
>> From:    "Chamberlain, James" <[log in to unmask]>
>> Subject: Re: Peds EM talk
>> 
>> I would also cover unusual cases that you can't afford to miss, e.g.
>> 
>> Sternoclavicular dislocation
>> Conjunctivitis caused by penetrating FB 
>> Septic joint presenting with only low-grade fever (we've had several Staph infections where temp was only 37.6 or 37.7 orally)
>> Myocarditis presenting as wheezing. Remind them that all "bronchiolitis" patients need a through cardiac exam, including distal pulses
>> NAT
>> The "sleepy" baby who has hypoglycemia
>> The "sleepy" baby who has intussusception
>> The appendicitis patient who presents with vomiting and diarrhea (not all that unusual, actually)
>> Etc.
>> 
>> To me, this is the challenge of PEM. Finding the needle in the haystack, that one sick kid who is different than all the usual low acuity illness...
>> 
>> Jim
>> 
>> James Chamberlain
>> Division Chief, Emergency Medicine
>> Children’s National Health System
>> (202) 476-4177
>> 
>> -----Original Message-----
>> From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Mojica, Michael
>> Sent: Thursday, February 15, 2018 5:29 PM
>> To: [log in to unmask]
>> Subject: Re: Peds EM talk
>> 
>> Purva
>> 
>> 
>> 
>> I would recommend "the critically ill infant". 
>> 
>> 
>> 
>> It is the topic that scares the most people and you can cover a lot of causes through cases.
>> 
>> 
>> 
>> I like to use cases that include common presenting complaints (e.g. vomiting) that are associated with very bad things (e.g. midgut volvulus).
>> 
>> 
>> 
>> I'm attaching a ppt file for a talk I did a few years ago on this topic.
>> 
>> 
>> 
>> My goal is for them to develop a mental checklist of potentially life-saving interventions.
>> 
>> 
>> 
>> Michael
>> 
>> 
>> 
>> Michael Mojica, M.D
>> 
>> Director of Education, Division of Pediatric Emergency Medicine
>> 
>> Director, Pediatric Emergency Medicine Fellowship
>> 
>> Bellevue Hospital Center
>> 
>> Administration Building Room A528
>> 
>> New York, N.Y. 10016
>> 
>> [log in to unmask]
>> 
>> 212-562-8147
>> 
>> 
>> 
>> 
>> 
>> On 2/15/18, 5:12 PM, "Pediatric Emergency Medicine Discussion List on behalf of Purva Grover" <[log in to unmask] on behalf of [log in to unmask]> wrote:
>> 
>> 
>> 
>>   Hi All
>> 
>>   I am giving an hour ppt to new PAs on Peds Emergencies. Clearly can not cover ALL or even most. Any thoughts / talks / power points- you could share would be appreciated. 
>> 
>>   Thanks
>> 
>>   Purva
>> 
>> 
>> 
>>   Sent from my mobile device 
>> 
>>   For more information, send mail to [log in to unmask] with the message: info PED-EM-L
>> 
>>   The URL for the PED-EM-L Web Page is:
>> 
>>                    https://urldefense.proofpoint.com/v2/url?u=http-3A__listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFAg&c=j5oPpO0eBH1iio48DtsedbOBGmuw5jHLjgvtN2r4ehE&r=-uVUSwDIF0s52hEnO0EzoINmOqevlfnirF7YJ_EXiAQ&m=c2wlkkLWVP009LBCXl-k6T4PNiNn1YYHTaSvJRCvGWo&s=7bcGZM66nE4BJGdqQQrjhL6fNRMBTCzuSv96wXa91qc&e=
>> 
>> 
>> 
>> 
>> 
>> 
>> ------------------------------------------------------------
>> This email message, including any attachments, is for the sole use of the intended recipient(s) and may contain information that is proprietary, confidential, and exempt from disclosure under applicable law. Any unauthorized review, use, disclosure, or distribution is prohibited. If you have received this email in error please notify the sender by return email and delete the original message. Please note, the recipient should check this email and any attachments for the presence of viruses. The organization accepts no liability for any damage caused by any virus transmitted by this email.
>> =================================
>> 
>> 
>> 
>> 
>> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
>> 
>> The URL for the PED-EM-L Web Page is:
>> 
>>                https://urldefense.proofpoint.com/v2/url?u=http-3A__listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=ZQaRUYHlbNuSLlAi-YuD0cY4QPsIIUqjaql9agkSHH8&s=jLXcVKFGHNLAQ-y3T0bMic8mmMkKMtSnWoO5UdsCqvM&e=
>> 
>> 
>> ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
>> Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.
>> 
>> 
>> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
>> The URL for the PED-EM-L Web Page is:
>>                http://listserv.brown.edu/ped-em-l.html
>> 
>> ------------------------------
>> 
>> Date:    Fri, 16 Feb 2018 18:29:38 -0500
>> From:    Aline Baghdassarian <[log in to unmask]>
>> Subject: Re: Bacterial meningitis
>> 
>> Scott,
>> 
>> Would love to hear more about the cases. How did they present? What was the
>> decision making process?
>> 
>> Thank you,
>> 
>> Aline
>> 
>> Aline Baghdassarian, MD, MPH, FAAP
>> Director, Pediatric Emergency Medicine Fellowship Program
>> Assistant Professor, Department of Emergency Medicine
>> Virginia Commonwealth University School of Medicine
>> 
>> Children's Hospital of Richmond at VCU
>> Email [log in to unmask]
>> 
>> 
>> On Thu, Feb 15, 2018 at 12:40 PM, Julian Orenstein <[log in to unmask]>
>> wrote:
>> 
>>> In a recent case at our institution, there was a present but subtle degree
>>> of meningismus — I’ve found over the years there is always some elicitable
>>> sign — but as importantly there’s a degree of irritability or altered
>>> behavior that has everyone concerned: mom, RN’s, me.
>>> If mama ain't happy, I ain't happy. I’ll make liberal use of the term
>>> cerebritis or encephalopathic behavior until there’s a consent signed.
>>> 
>>> I’m not such a good scientist anymore, but I’ve tried to be an attentive
>>> clinician.
>>> 
>>> Julian Orenstein
>>> 
>>> 
>>>> On Feb 14, 2018, at 3:30 PM, JAY FISHER <[log in to unmask]> wrote:
>>>> 
>>>> Scott - Bacterial meningitis is alive and well here in LV - we have seen
>>> it in a variety of age groups. There is good evidence that there has been
>>> an increase in pneumococcal serotypes not covered by the polyvalent
>>> vaccines since there widespread use, such that the burden of pneumococcal
>>> meningitis (as opposed to H. flu type b) has not decreased nearly as much.
>>>> 
>>>> Brouwer MC, van de Beek D. Epidemiology of community-acquired bacterial
>>> meningitis. Curr Opin Infect Dis. 2018;31(1):78-84.
>>>> 
>>>> Also, the absence of meningismus in older kids with bacterial meningitis
>>> is well described and occurs in a substantial subset.
>>>> 
>>>> Geiseler J, Nelson, K.E. Bacterial meningitis without clinical signs of
>>> meningeal irritation. . Southern Med J 1982;75(4):448-450.
>>>> 
>>>> Much of the data on the sensitivity of the neck exam is of the
>>> retrospective variety. I have only read one really good prospective study
>>> on the sensitivity of PE for bacterial meningitis and it was a single
>>> center variety as I recall.
>>>> 
>>>> Walsh-Kelly C, Nelson DB, Smith DS, et al. Clinical predictors of
>>> bacterial versus aseptic meningitis in childhood. Ann Emerg Med.
>>> 1992;21(8):910-914.
>>>> 
>>>> Tough case.
>>>> 
>>>> 
>>>> Jay
>>>> 
>>>> Jay D. Fisher MD FAAP FACEP
>>>> Medical Director, Pediatric EM
>>>> Children's Hospital of Nevada at UMC
>>>> Clinical Professor of Emergency Medicine and Pediatrics
>>>> UNLV School of Medicine
>>>> 
>>>> 
>>>> 
>>>> 
>>>> 
>>>> 
>>>> 
>>>> 
>>>>> On February 14, 2018 at 4:18 PM "Conners, Gregory, P" <
>>> [log in to unmask]> wrote:
>>>>> 
>>>>> 
>>>>> I shared this with our ID director (Dr. Mary Anne Jackson), who pointed
>>> out that bacterial meningitis appears at this time of year as a
>>> complication of influenza:
>>>>> "Both pneumococcal and meningococcal meningitis can occur post flu as
>>> well as GAS and S aureus invasive disease and TSS."
>>>>> 
>>>>> She also addressed Jim's question:  "We do know that new serotypes [of
>>> pneumococcus] have emerged but this is not waning immunity because the teen
>>> only got PCV7".
>>>>> 
>>>>> 
>>>>> Greg Conners
>>>>> 
>>>>> Gregory P. Conners, MD, MPH, MBA, FAAP, FACEP
>>>>> 
>>>>> Director, Division of Emergency Medicine
>>>>> Associate Chair of Pediatrics
>>>>> Professor of Pediatrics and Emergency Medicine
>>>>> Children’s Mercy Hospital, Kansas City
>>>>> University of Missouri, Kansas City
>>>>> [log in to unmask]
>>>>> 
>>>>> 
>>>>> 
>>>>> 
>>>>> -----Original Message-----
>>>>> From: Pediatric Emergency Medicine Discussion List [mailto:
>>> [log in to unmask]] On Behalf Of 000001679b145c30-dmarc-
>>> [log in to unmask]
>>>>> Sent: Wednesday, February 14, 2018 2:25 PM
>>>>> To: [log in to unmask]
>>>>> Subject: Re: Bacterial meningitis
>>>>> 
>>>>> *** This message was sent to you from an External Source. Please do not
>>> open untrusted links or attachments. ***
>>>>> 
>>>>> ________________________________
>>>>> 
>>>>> 
>>>>> Could you share with us the clinical findings and history that prompted
>>> the LP?
>>>>> 
>>>>> 
>>>>> Shiu-Lin
>>>>> 
>>>>> 
>>>>> 
>>>>> 
>>>>> Shiu-Lin Tsai, MD
>>>>> Division of Pediatric Emergency Medicine
>>>>> 
>>>>> Department of Emergency Medicine
>>>>> Columbia University Medical Center
>>>>> 
>>>>> 
>>>>> 
>>>>> -----Original Message-----
>>>>> From: Scott Freedman <[log in to unmask]>
>>>>> To: PED-EM-L <[log in to unmask]>
>>>>> Sent: Wed, Feb 14, 2018 2:44 pm
>>>>> Subject: Bacterial meningitis
>>>>> 
>>>>> ALL:
>>>>> Since Jan 1st this year, we have seen 3 cases of culture + bacterial
>>> meningitis come through are ED;  2 with *Strep pneumoniae* and 1 with
>>> *Neisseria meningiditis*.  All 3 were in older children/ teens who received
>>> their Prevnar 13  vaccines as well as the Menactra series in the patient
>>> with Neisseria.  Anyone else seeing cases of this sort?  I do not recall 3
>>> cases of bacterial meningitis in older kids in a community setting such as
>>> ours in quite a long time.  Is this random bad luck or do  we all need to
>>> be more vigilant?  Incidentally, none had neck pain or meningismus as a
>>> clinical finding.
>>>>> 
>>>>> --
>>>>> Kind regards,
>>>>> 
>>>>> Scott
>>>>> Scott Freedman, MD
>>>>> Medical Director,  Pediatric Emergency Dept Rockville MD
>>>>> 
>>>>> For more information, send mail to [log in to unmask] with
>>> the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
>>>>>               http://listserv.brown.edu/ped-em-l.html
>>>>> 
>>>>> 
>>>>> For more information, send mail to [log in to unmask] with
>>> the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
>>>>>               http://listserv.brown.edu/ped-em-l.html
>>>>> 
>>>>> ________________________________
>>>>> 
>>>>> Electronic mail from Children's Mercy Kansas City. This communication
>>> is intended only for the use of the addressee. It may contain information
>>> that is privileged or confidential under applicable law. If you are not the
>>> intended recipient or the agent of the recipient, you are hereby notified
>>> that any dissemination, copy or disclosure of this communication is
>>> strictly prohibited. If you have received this communication in error,
>>> please immediately forward the message to the Children's Mercy Information
>>> Security Officer via return electronic mail at informationsecurityofficer@
>>> cmh.edu and expunge this communication without making any copies. Thank
>>> you for your cooperation.
>>>>> 
>>>>> For more information, send mail to [log in to unmask] with
>>> the message: info PED-EM-L
>>>>> The URL for the PED-EM-L Web Page is:
>>>>>               http://listserv.brown.edu/ped-em-l.html
>>>> 
>>>> For more information, send mail to [log in to unmask] with the
>>> message: info PED-EM-L
>>>> The URL for the PED-EM-L Web Page is:
>>>>               http://listserv.brown.edu/ped-em-l.html
>>> 
>>> For more information, send mail to [log in to unmask] with the
>>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>                http://listserv.brown.edu/ped-em-l.html
>>> 
>> 
>> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
>> The URL for the PED-EM-L Web Page is:
>>                http://listserv.brown.edu/ped-em-l.html
>> 
>> ------------------------------
>> 
>> Date:    Fri, 16 Feb 2018 18:29:08 -0500
>> From:    Martin Pusic <[log in to unmask]>
>> Subject: The shooting in Florida
>> 
>> Hi colleagues,
>> 
>> As I sit in my office late on a Friday, I've gotten myself into a state about the 17 children gunned down in a school.  For the umpteenth time. 
>> 
>> I think the thing that has me so upset, is that this state of gun complaisance is an affront to everything a pediatric emergency physician stands for.  We sweat whether it's too risky when the WBC is 15.1 and not 14.9.  We study 40,000 children in order sort out who deserves the x-ray risk of a maybe brain tumor 30 years from now.  We work in difficult, burnout inducing conditions so that we can personally save, say, one life a year. 
>> 
>> Today it feels to me like someone with an AK-whatever just wiped out 17 years of my work.  In minutes.  I want to cry.  We SHOULD cry.  Try and watch that Parkland mother on CNN.  I dare you. 
>> 
>> Today is not a day like all the others.  It's just not.
>> 
>> --Martin Pusic
>> 
>> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
>> The URL for the PED-EM-L Web Page is:
>>                http://listserv.brown.edu/ped-em-l.html
>> 
>> ------------------------------
>> 
>> End of PED-EM-L Digest - 15 Feb 2018 to 16 Feb 2018 (#2018-39)
>> **************************************************************
> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                 http://listserv.brown.edu/ped-em-l.html

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html

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