Episode: 138: Objective Data, What Other Doctors Would Do and Making Nurses Aware

Most of us physicians shy away from the legal aspects of PEM. Nobody likes to get sued and many of us want to be as far away from court as possible. That is why I brought Dr. Rick Saladino back on the show to give us some advice in case we need to be on  "the stand". 

Are most children vaccinated? why do parents refuse to vaccinate ? where did it call come from? and what I the relationship between MMR vaccine and autism. I discuss those questions and other important topics with Dr. John Snyder who was my attending back in residency. 

In this segment of "Dr. Jay Fisher's List of I Never Want to Miss It" we discuss one of the most challenging diagnosis to make (and manage) in the Pediatric ED. Myocarditis. As always, Dr. Fisher has some great tips and advice. Here are some of the references Jay is referring to in the Podcast ------------------------------------------------------------------ Law YM et al. Diagnosis and Management of Myocarditis in Children.A Scientific Statement From the American Heart Association Circulation. 2021;144:e123–e135.   Freedman SP et al. Pediatric Myocarditis: Emergency Department Clinical Findings and Diagnostic Evaluation. Pediatrics. Volume 120, Number 6, December 2007: 1279-1285.   Genadry A Prediction Rule to Identify Children and Young Adults at Low Risk for Myocarditis. Ped Emerg Care 2025;Volume 41, Number 5, May 2025: 388-394.     Please consider contributing to PEM Rules at https://ko-fi.com/pemrules And check out www.pemrules.com Copyright PEM Rules LLC   DISCLAIMER By listening to this podcast, you agree not to use these resources as medical advice to treat any medical conditions in either yourself or others, including, but not limited to, patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or website. Under no circumstances shall PEM Rules, the PEM Rules podcast or any guests or affiliated entities be responsible for damages arising from their use. This podcast should not be used in any legal capacity whatsoever, including, but not limited to, establishing "standard of care" in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the website or in the podcast.              

As if being a PEM doctor is not hard (and busy) enough, some of us out there spend countless hours educating the next generation. One of those people is Dr. Emily Rose whose work in PEM education is truly inspiring and is the reason I invited her to the show.  

I am very excited to share that on a recent article by FeedSpot Podcasts (a searchable directory and media contact database that catalogs millions of active podcasts across thousands of specialized niches) PEM Rules was ranked number 19 out of the 40 best Pediatric Podcast. T his is a huge achievement (especially considering that there are over 1100 Pediatric Podcasts out there). So thank YOU the listeners and downloaders wherever you are. It is highly appreciated. This would not be possible without YOU.  Here is the Link to the article: https://podcast.feedspot.com/pediatric_podcasts/?feed_id=5404042&_src=f1_featured_email#h5404042  

sometimes beyond the subjective complaints there are objective findings, that is when I get considerably more worried about my patients that perhaps there is something serious.

Though I am a Pediatric Emergency Provider, most of the time I don't treat true emergencies. Intensive care is a fairly small portion of what I do. That is why I invited Dr. Matt Goldstein, a PICU doctor from NY to come on the show and discuss the 5 things PICU docs want PEM docs to know…  Low threshold to call and communicate concerns regarding a decompensating patient. Identify high risk intubations Try and get as much history as possible (understanding how busy ED is) Reassess ICU level patients once they are admitted (every hospital is different) The power of airway clearance (especially in children with complex care needs, tracheostomy etc)

Thank you for all of you who have been listening and learning. PEM Rules is (almost) done with summer break and will be back next Monday on August 31. Please tune in. We have great guests and great topics coming up this year. 

As in the past, PEM Rules is going to take a summer break to allow me to gather some more material and invite more guests. As always, thank you for the support.  Please consider contributing to PEM Rules at the following link  https://ko-fi.com/pemrules If you are interested in some PEM Rules merchandise, check out the PEM Rules store.  https://www.redbubble.com/shop/ap/164385928    

Sometimes the H&P is clouded (for whatever reason) that is a good time to get some objective data (easier said than done) why I think of what other doctors will do and why it is important to plan with the nurse.