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PED-EM-L  February 2018

PED-EM-L February 2018

Subject:

Re: PED-EM-L Digest - 4 Feb 2018 to 5 Feb 2018 (#2018-30)

From:

Martin Herman <[log in to unmask]>

Reply-To:

Martin Herman <[log in to unmask]>

Date:

Tue, 6 Feb 2018 13:59:38 +0000

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (1 lines)

If you were the Peds attending that made the referral, why weren’t you called back with the results and for discussion on dispo?
Why didn’t you admit?

Marty
[X]

Martin (Marty) Herman
USAPA Ambassador for Pickleball , North Mississippi.
Tupelo Pickleball ( facebook)
[log in to unmask]<mailto:[log in to unmask]>
901 219 9202
Sent from my iPhone


On Feb 5, 2018, at 11:00 PM, PED-EM-L automatic digest system <[log in to unmask]<mailto:[log in to unmask]>> wrote:

There are 6 messages totaling 461 lines in this issue.

Topics of the day:

 1. open position
 2. PED-EM-L Digest - 3 Feb 2018 to 4 Feb 2018 (#2018-29)
 3. Fever in Baby (4)

For more information, send mail to [log in to unmask]<mailto:[log in to unmask]> with the message: info PED-EM-L
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----------------------------------------------------------------------

Date:    Sun, 4 Feb 2018 22:12:14 -0500
From:    Devra Gutfreund <[log in to unmask]<mailto:[log in to unmask]>>
Subject: open position

OPEN POSITIONS:

MEDICAL DIRECTOR: St. Joseph's Hospital and Medical Center, Division of
Pediatric Emergency Medicine is seeking a full time physician for Pediatric
Emergency Medicine Medical Director.  St. Joseph's Hospital and Medical
Center is located in Paterson, NJ, minutes from NYC.  It is affiliated with
New York medical College and medical students from the US and abroad rotate
through the ED.

The Peds ED cares for over 41,000 acutely ill or injured children annually.
Overall, the ED sees 170k+/yr

The hospital is a Level II Trauma center and has specialized EMS, Critical
Care and Emergency teams. Home to the vision of Alternatives to Opiods
Program (ALTO) enjoy full practice support including scribes: PICU and NICU
and full ancillary services. All major pediatric subspecialties services
are provided.

Our Department of Pediatric Emergency Medicine has 10 full-time and
part-time attending physicians and is also home to an outstanding EM
Residency and Pediatric Residency Program.

We offer a competitive salary and excellent benefits. For additional
information, please contact

Mark Rosenberg, DO, MBA, FACEP, FAAHPM

email: [log in to unmask]<mailto:[log in to unmask]>

Chairman, Emergency Medicine

Chief Innovation Officer (CINO)

Associate Professor Emergency Medicine

St Joseph’s Health-NJ

Board of Directors - American College of Emergency Physicians (ACEP)

973.224.0570



PEM POSITIONS:  St Joseph's Hospital and Medical Center, Division of
Pediatric Emergency Medicine is seeking TWO full time physician for
Pediatric Emergency Medicine physicians to join our team.

Minimum requirements: The successful candidate will have completed a
fellowship in Pediatric Emergency Medicine and be Board certified or Board
prepared in Pediatrics and sub-boarded in Pediatric Emergency Medicine.

Our Department of Pediatric Emergency Medicine has 10 full-time and
part-time attending physicians and is also home to an outstanding EM
Residency and Pediatric Residency Program. Enjoy full practice support
including scribes: PICU and NICU and full ancillary services. All major
pediatric subspecialties services are provided.

We offer a competitive salary and excellent benefits. For additional
information, please contact

Mark Rosenberg, DO, MBA, FACEP, FAAHPM

email: [log in to unmask]<mailto:[log in to unmask]>

Chairman, Emergency Medicine

Chief Innovation Officer (CINO)

Associate Professor Emergency Medicine

St Joseph’s Health-NJ

Board of Directors - American College of Emergency Physicians (ACEP)


973.224.0570




NOCTURNIST:

PEM Positions:  St Joseph's Hospital and Medical Center, Division of
Pediatric Emergency Medicine is seeking a Nocturnist for the Pediatric
Emergency Medicine department to join our team. Just minutes from NYC.
Enjoy full practice support including scribes: PICU and NICU and full
ancillary services. All major pediatric subspecialties services are
provided.

Minimum requirements: The successful candidate will have completed a
fellowship in Pediatric Emergency Medicine and be Board certified or Board
prepared in Pediatrics and sub-boarded in Pediatric Emergency Medicine.

Our Department of Pediatric Emergency Medicine has 10 full-time and
part-time attending physicians and is also home to an outstanding EM
Residency and Pediatric Residency Program.

We offer a competitive salary and excellent benefits. For additional
information, please contact

Mark Rosenberg, DO, MBA, FACEP, FAAHPM

email: [log in to unmask]<mailto:[log in to unmask]>

Chairman, Emergency Medicine

Chief Innovation Officer (CINO)

Associate Professor Emergency Medicine

St Joseph’s Health-NJ

Board of Directors - American College of Emergency Physicians (ACEP)


973.224.0570

For more information, send mail to [log in to unmask]<mailto:[log in to unmask]> with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
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------------------------------

Date:    Mon, 5 Feb 2018 14:21:39 +0000
From:    Martin Herman <[log in to unmask]<mailto:[log in to unmask]>>
Subject: Re: PED-EM-L Digest - 3 Feb 2018 to 4 Feb 2018 (#2018-29)

Mick,

the ABP can probably help
AAP and ACEP might also be good resourceS

MARTY

btw, I retired 3 years ago.
[X]

Martin (Marty) Herman
USAPA Ambassador for Pickleball , North Mississippi.
Tupelo Pickleball ( facebook)
[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>
901 219 9202
Sent from my iPhone


On Feb 4, 2018, at 11:01 PM, PED-EM-L automatic digest system <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote:

There is 1 message totaling 60 lines in this issue.

Topics of the day:

1. PED-EM-L Digest - 1 Feb 2018 to 3 Feb 2018 (#2018-28)

For more information, send mail to [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]> with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
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----------------------------------------------------------------------

Date:    Sun, 4 Feb 2018 08:10:38 -0500
From:    Mick Work <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>>
Subject: Re: PED-EM-L Digest - 1 Feb 2018 to 3 Feb 2018 (#2018-28)

Anyone know the best source of pem contacts?   Mailing list?

Especially interested in reaching out to the first generations of individuals retired or nearly retired in our field.

Thanks

Mick Connors



On Feb 4, 2018, at 12:00 AM, PED-EM-L automatic digest system <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote:

There is 1 message totaling 17 lines in this issue.

Topics of the day:

1. Time May Be of the Essence in Refractory Status Epilepticus in children

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----------------------------------------------------------------------

Date:    Sat, 3 Feb 2018 08:41:42 -0500
From:    Itai Shavit <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>>
Subject: Time May Be of the Essence in Refractory Status Epilepticus in children

Time May Be of the Essence in Refractory Status Epilepticus in children

https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.pemdatabase.org%2F&data=02%7C01%7C%7C922c706c7bf74095211c08d56c5573fc%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636534036633970466&sdata=uyhyIkNeyZvkQbs932ceePnwcGb2wqXZac7bHAIyyPo%3D&reserved=0

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------------------------------

End of PED-EM-L Digest - 1 Feb 2018 to 3 Feb 2018 (#2018-28)
************************************************************

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------------------------------

End of PED-EM-L Digest - 3 Feb 2018 to 4 Feb 2018 (#2018-29)
************************************************************

For more information, send mail to [log in to unmask]<mailto:[log in to unmask]> with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
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------------------------------

Date:    Mon, 5 Feb 2018 16:55:42 +0200
From:    Kevin Schreiber <[log in to unmask]<mailto:[log in to unmask]>>
Subject: Fever in Baby

Hello all,
It seems like we can never get away from this issue.
I am a Peds EM doc who also works in a peds practice.
Recently saw a vaccinated 2.5 month old baby girl with a known history of a
solitary kidney and possible bladder diverticulum who presented to me with
a URI symptoms and a tactile temp. Happy, Interactive, no vomiting.
In clinic had a temp of 38.7. Exam unremarkable except for mild
rhinorrhea.  Received TylenoI.  I explained to the family that I felt there
should go to the ER and if there was a suspicion for a UTI, they would need
admission for IV antibiotics.
In the ED, had a CBC, Electrolytes, Blood Culture, UA, UCX and CRP
CBC WBC=9.8, no left shift, BUN CREAT normal, Glucose 101, Crp 0.26
UA (suprabic) Leuk esterase 3+, Nitrite +
The baby was sent home with oral antibiotics, to follow up as an outpatient.
I was perplex and confused with the decision for no IV  antibiotics,
especially with the solitary kidney history, Would a normal CBC / CRP sway
your thought process?
Comments? Thoughts?
Thank!
Kevin Schreiber
PEM Attending

For more information, send mail to [log in to unmask]<mailto:[log in to unmask]> with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                https://nam02.safelinks.protection.outlook.com/?url=http%3A%2F%2Flistserv.brown.edu%2Fped-em-l.html&data=02%7C01%7C%7Cfda7c329eaa64460bcf808d56d1e801c%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636534900133174325&sdata=7ticeQx22z8XtnNe4hm7hqhboadKWoPeCbQC6o9615Y%3D&reserved=0

------------------------------

Date:    Mon, 5 Feb 2018 15:08:47 +0000
From:    Doc Holiday <[log in to unmask]<mailto:[log in to unmask]>>
Subject: Re: Fever in Baby

Might make a difference in weighing options if you could clarify the following:

- Which is the oral antibiotic given

- Which is the IV antibiotic you would have expected to be given

- Is there any suspicion of an issue with the absorption of an oral drug? You have already stated that there is no vomiting; is there a mal-absorption condition of suspicion thereof?


________________________________
From: Pediatric Emergency Medicine Discussion List <[log in to unmask]<mailto:[log in to unmask]>> on behalf of Kevin Schreiber <[log in to unmask]<mailto:[log in to unmask]>>
Sent: 05 February 2018 14:55
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Fever in Baby

Hello all,
It seems like we can never get away from this issue.
I am a Peds EM doc who also works in a peds practice.
Recently saw a vaccinated 2.5 month old baby girl with a known history of a
solitary kidney and possible bladder diverticulum who presented to me with
a URI symptoms and a tactile temp. Happy, Interactive, no vomiting.
In clinic had a temp of 38.7. Exam unremarkable except for mild
rhinorrhea.  Received TylenoI.  I explained to the family that I felt there
should go to the ER and if there was a suspicion for a UTI, they would need
admission for IV antibiotics.
In the ED, had a CBC, Electrolytes, Blood Culture, UA, UCX and CRP
CBC WBC=9.8, no left shift, BUN CREAT normal, Glucose 101, Crp 0.26
UA (suprabic) Leuk esterase 3+, Nitrite +
The baby was sent home with oral antibiotics, to follow up as an outpatient.
I was perplex and confused with the decision for no IV  antibiotics,
especially with the solitary kidney history, Would a normal CBC / CRP sway
your thought process?
Comments? Thoughts?
Thank!
Kevin Schreiber
PEM Attending

For more information, send mail to [log in to unmask]<mailto:[log in to unmask]> with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                https://nam02.safelinks.protection.outlook.com/?url=http%3A%2F%2Flistserv.brown.edu%2Fped-em-l.html&data=02%7C01%7C%7Cfda7c329eaa64460bcf808d56d1e801c%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636534900133174325&sdata=7ticeQx22z8XtnNe4hm7hqhboadKWoPeCbQC6o9615Y%3D&reserved=0

For more information, send mail to [log in to unmask]<mailto:[log in to unmask]> with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                https://nam02.safelinks.protection.outlook.com/?url=http%3A%2F%2Flistserv.brown.edu%2Fped-em-l.html&data=02%7C01%7C%7Cfda7c329eaa64460bcf808d56d1e801c%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636534900133174325&sdata=7ticeQx22z8XtnNe4hm7hqhboadKWoPeCbQC6o9615Y%3D&reserved=0

------------------------------

Date:    Mon, 5 Feb 2018 17:14:58 +0000
From:    "Shah, Lekha" <[log in to unmask]<mailto:[log in to unmask]>>
Subject: Re: Fever in Baby

Hi Kevin
I would have admitted since the kid relies on the solitary kidney for renal function. It almost doesn’t matter that the kid looks good with that particular background Pmhx
My two cents...
Lekha

Sent from my iPhone

On Feb 5, 2018, at 9:56 AM, Kevin Schreiber <[log in to unmask]<mailto:[log in to unmask]>> wrote:

Hello all,
It seems like we can never get away from this issue.
I am a Peds EM doc who also works in a peds practice.
Recently saw a vaccinated 2.5 month old baby girl with a known history of a
solitary kidney and possible bladder diverticulum who presented to me with
a URI symptoms and a tactile temp. Happy, Interactive, no vomiting.
In clinic had a temp of 38.7. Exam unremarkable except for mild
rhinorrhea.  Received TylenoI.  I explained to the family that I felt there
should go to the ER and if there was a suspicion for a UTI, they would need
admission for IV antibiotics.
In the ED, had a CBC, Electrolytes, Blood Culture, UA, UCX and CRP
CBC WBC=9.8, no left shift, BUN CREAT normal, Glucose 101, Crp 0.26
UA (suprabic) Leuk esterase 3+, Nitrite +
The baby was sent home with oral antibiotics, to follow up as an outpatient.
I was perplex and confused with the decision for no IV  antibiotics,
especially with the solitary kidney history, Would a normal CBC / CRP sway
your thought process?
Comments? Thoughts?
Thank!
Kevin Schreiber
PEM Attending

For more information, send mail to [log in to unmask]<mailto:[log in to unmask]> with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
               https://nam02.safelinks.protection.outlook.com/?url=http%3A%2F%2Flistserv.brown.edu%2Fped-em-l.html&data=02%7C01%7C%7Cfda7c329eaa64460bcf808d56d1e801c%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636534900133174325&sdata=7ticeQx22z8XtnNe4hm7hqhboadKWoPeCbQC6o9615Y%3D&reserved=0

________________________________

This e-mail message (including any attachments) is for the sole use of
the intended recipient(s) and may contain confidential and privileged
information. If the reader of this message is not the intended
recipient, you are hereby notified that any dissemination, distribution
or copying of this message (including any attachments) is strictly
prohibited.

If you have received this message in error, please contact
the sender by reply e-mail message and destroy all copies of the
original message (including attachments).

For more information, send mail to [log in to unmask]<mailto:[log in to unmask]> with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                https://nam02.safelinks.protection.outlook.com/?url=http%3A%2F%2Flistserv.brown.edu%2Fped-em-l.html&data=02%7C01%7C%7Cfda7c329eaa64460bcf808d56d1e801c%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636534900133174325&sdata=7ticeQx22z8XtnNe4hm7hqhboadKWoPeCbQC6o9615Y%3D&reserved=0

------------------------------

Date:    Mon, 5 Feb 2018 18:31:21 +0000
From:    "Chamberlain, James" <[log in to unmask]<mailto:[log in to unmask]>>
Subject: Re: Fever in Baby

While oral medication is acceptable for the treatment of pyelo in infants1, I would also be more aggressive in this patient with a solitary kidney. I would opt for an IV or IM dose of ceftriaxone, followed by outpatient oral meds and close follow-up.



If the patient had a history of infection with organisms with different antibiotic resistance patterns (e.g. Pseudomonas), I would admit for broader coverage pending identification of the organism.



Jim



James Chamberlain

Division Chief, Emergency Medicine

Children’s National Health System

(202) 476-4177





1 Pediatrics

July 1999, VOLUME 104 / ISSUE 1

Oral Versus Initial Intravenous Therapy for Urinary Tract Infections in Young Febrile Children

Alejandro Hoberman, Ellen R. Wald, Robert W. Hickey, Marc Baskin, Martin Charron, Massoud Majd, Diana H. Kearney, Ellen A. Reynolds, Jerry Ruley, Janine E. Janosky



-----Original Message-----
From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Shah, Lekha
Sent: Monday, February 05, 2018 12:15 PM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: Fever in Baby



Hi Kevin

I would have admitted since the kid relies on the solitary kidney for renal function. It almost doesn’t matter that the kid looks good with that particular background Pmhx

My two cents...

Lekha





Sent from my iPhone





On Feb 5, 2018, at 9:56 AM, Kevin Schreiber <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote:





Hello all,

It seems like we can never get away from this issue.

I am a Peds EM doc who also works in a peds practice.

Recently saw a vaccinated 2.5 month old baby girl with a known history of a

solitary kidney and possible bladder diverticulum who presented to me with

a URI symptoms and a tactile temp. Happy, Interactive, no vomiting.

In clinic had a temp of 38.7. Exam unremarkable except for mild

rhinorrhea.  Received TylenoI.  I explained to the family that I felt there

should go to the ER and if there was a suspicion for a UTI, they would need

admission for IV antibiotics.

In the ED, had a CBC, Electrolytes, Blood Culture, UA, UCX and CRP

CBC WBC=9.8, no left shift, BUN CREAT normal, Glucose 101, Crp 0.26

UA (suprabic) Leuk esterase 3+, Nitrite +

The baby was sent home with oral antibiotics, to follow up as an outpatient.

I was perplex and confused with the decision for no IV  antibiotics,

especially with the solitary kidney history, Would a normal CBC / CRP sway

your thought process?

Comments? Thoughts?

Thank!

Kevin Schreiber

PEM Attending





For more information, send mail to [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]> with the message: info PED-EM-L

The URL for the PED-EM-L Web Page is:

               https://nam02.safelinks.protection.outlook.com/?url=https%3A%2F%2Furldefense.proofpoint.com%2Fv2%2Furl%3Fu%3Dhttp-3A__listserv.brown.edu_ped-2Dem-2Dl.html%26d%3DDwIGaQ%26c%3DZoipt4Nmcnjorr_6TBHi1A%26r%3DOEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg%26m%3DSjFjOu-2UQsr3YtZjf4DjuaMzywH9zb_If--1ZtpgYE%26s%3D-6NO4b_WEtDOrJ4nv7EAu2lEiKd9rRrC-bRWef9hb4Y%26e&data=02%7C01%7C%7Cfda7c329eaa64460bcf808d56d1e801c%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636534900133174325&sdata=Bru0K%2BKW1OnuxyYPBCLCj55lG5GFlluUovFHC4YVs7k%3D&reserved=0=





________________________________





This e-mail message (including any attachments) is for the sole use of

the intended recipient(s) and may contain confidential and privileged

information. If the reader of this message is not the intended

recipient, you are hereby notified that any dissemination, distribution

or copying of this message (including any attachments) is strictly

prohibited.





If you have received this message in error, please contact

the sender by reply e-mail message and destroy all copies of the

original message (including attachments).





For more information, send mail to [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]> with the message: info PED-EM-L

The URL for the PED-EM-L Web Page is:

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------------------------------

End of PED-EM-L Digest - 4 Feb 2018 to 5 Feb 2018 (#2018-30)
************************************************************

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