Course Descriptions

Beyond Benzodiazepines: Advanced Therapy for Refractory Epilepticus
1 Hour
Faculty: Jill M. Baren, MD, MBE, FACEP, FAAP
Seizures that do not cease within 5-10 minutes are unlikely to terminate without intervention and those that continue for more than 30 minutes pose significant risk for severe neurological morbidity and even death. First and second line anticonvulsants are frequently used by emergency physicians but when status epilepticus is refractory to these therapies, what should be done next? This course will review recent literature on the treatment of refractory status epilepticus and discuss the pharmacology of newer antiepileptic agents that may be used for this purpose.

Cervical Spine Injury in Children: Controversies in Management
1 Hour
Faculty: Julie C R Leonard, MD, MPH
Cervical spine injuries in children are rare, but potentially devastating.  ATLS protocols mandate early rigid immobilization and imaging for many child trauma victims, few of whom actually have cervical spine injury. There are also well documented iatrogenic sequelae of immobilization. Recent attempts by both Canadian and American investigators to develop risk stratification strategies differ from each other and neither was derived using large samples of children. What is the best imaging strategy for suspected C-spine injury? This lecture will explore the management issues of immobilization, imaging and glucocorticoid management, highlighting the recently published NEXUS and Canadian cervical spine evaluation rules.

CT Imaging for Mild Pediatric Head Trauma: Best and Most Recent Evidence
1 Hour
Faculty: Nathan Kupperman, MD, MPH, FAAP
There are over 500,000 emergency department visits each year due to head trauma, criteria for the selection of children for CT imaging have been based on sparse data. Dr. Kuppermann will review the most current evidence-based approach to the evaluation of children with blunt head trauma.

.

Don’t Become Sharkbait: Medical-legal Misadventures to Avoid
1 Hour
Faculty: Gregory P. Moore, MD, JD
“Remember that patient you sent home last night at the end of your shift?” When you hear this from a colleague, a sudden chill runs through your body as you wrack your brain to remember what you might have missed. Preventable medical-legal misadventures will be discussed in a case-based fashion that might just help you avoid disaster by learning from the mistakes of others.

Evidence-based Approach to Wound Care: What Should You Put In or On Wounds?
1/2 Hour
Faculty: Brant A. Putnam, MD, FACS
Do topical antimicrobials (Bacitracin, Silvadene, etc.) promote or interfere with wound healing? What exactly are “semi-permeable wound dressings” and when should you use them?  Can the hemostatic powders and bandages currently used by the military be beneficial in the civilian setting? When and how should you pack a wound? This speaker will present an evidence-based approach to these and other questions related to wound care.

Fluid Resuscitation in Pediatric Trauma:  What Should I Give & How Fast Should I Give It?
1/2 Hour
Faculty: Brant A. Putnam, MD, FACS
Standard approaches to trauma induced hemorrhagic hypotension include vigorous fluid resuscitation.Yet, there are still concerns that this approach could exacerbate stabilized hypotensive hemorrhagic shock. Furthermore, there are new data regarding the types of fluid and the up-regulation of cellular injury markers. The latest evidence regarding trauma fluid resuscitation in children will be discussed.

Hematuria after Blunt Trauma in Children: Do Adult Diagnostic Criteria Apply?
1/2 Hour
Faculty: Nicholas C. Saenz , MD, FACS, FAAP
Children have unique anatomical characteristics that make renal trauma more common. Approximately 15% of children with minor trauma and hematuria have associated genitourinary abnormalities. Given these differences in adult and pediatric patients, do diagnostic criteria for imaging the GU tract designed for the adult blunt trauma patient apply for children? Should there be a number of red cells that are used to determine diagnostic evaluation or should patients with gross hematuria, shock, or major associated injury only be imaged to assess for GU tract injury?

Improving Patient Safety for Children in the ED: Practical Solutions
1 1/2 Hour
Faculty: David M. Jaffe, MD, FACEP, FAAP (Moderator)
Karen Frush, BSN, MD, FAAP
Richard M. Ruddy, MD, FACEP, FAAP

     Pediatric emergency care is high risk, and highly complex. Thus emergency providers are at risk of making errors every shift. As emergency practitioners, what can we do to contribute to the climate of safety for children in emergency settings? This expert panel will discuss recent patient safety recommendations for children and discuss activities that have been shown to identify and mitigate risk to patients in emergency settings, such as safety walk rounds, local safety teams, use of pediatric simulators, and a voluntary reporting system.

Long QT Syndrome (Cardiac Channelopathies): When to Worry, What to Do
1/2 Hour
Faculty: Anjan Batra, MD, FACC
Sudden cardiac death and the association with congenital long QT syndrome and other cardiac channelopathies has received much attention in the past decade. LQTS is a leading cause of sudden cardiac death, and dramatic advances in the understanding of this entity, genetics, phenotypic expression, and management has brought bench research to the clinician. This discussion will provide updates on clinical and genetic diagnosis, drugs that can prolong the QT and increase the risk of fatal dysrhythmias, guidelines for eligibility for sports activity, and predisposing risk factors. Implications of post-mortem channelopathy diagnosis (the molecular autopsy) on surviving relatives also will be discussed.

Managing Tuberculosis in Children in the 21st Century
1/2 Hour
Faculty: Jeffrey Starke, MD, FAAP
Tuberculosis is still the leading cause of death from a curable infection worldwide. Clinical manifestations of TB in children differ significantly from adults and vary by age. This expert lecturer will describe the emergency diagnosis and management of various manifestations of TB in children including pulmonary, pleural, pericardial, skeletal, superficial lymph nodes, and CNS disease. Complications of TB drug treatments and how to manage the positive PPD for children in the ED also will be discussed.

Meningitis: Time for “New Rules”?
1/2 Hour
Faculty: Nathan Kuppermann, MD, MPH, FAAP
Effective vaccines for H influenzae Type B and seven strains of S. pneumoniae have significantly reduced the incidence of bacterial meningitis in children. Children with CSF pleocytosis are routinely admitted to receive parenteral antibiotics, yet few have bacterial meningitis. Can we safely send some of these children home from the ED? Recently, new criteria for evaluating CSF have been determined and validated. This expert will present these new criteria and illustrate how they might be used in clinical emergency practice. Case-based examples will be provided.

Noninvasive Ventilation in Pediatric Emergency Medicine
1/2 Hour
Faculty: Nick Anas, MD
Noninvasive ventilation has been used extensively for COPD, CHF and obstructive sleep apnea in adults, but what are the uses in infants and children? A crashing asthmatic, an infant with bronchopulmonary dysplasia, or cystic fibrosis, a child with pneumonia may benefit from bi-level positive pressure ventilation (BiPAP). This expert will discuss the recent literature of the use of BiPAP in the pediatric population and describe how and when to apply it.

Pediatric Chest Pain: When to Worry
1 Hour
Faculty: Ghazala Sharieff, MD, FACEP, FAAP
Chest pain in children and adolescents is most often found to be of musculoskeletal or trivial origin. Occasionally you find a child with serious ischemic or inflammatory causes.  In a case-based format, some serious and even life-threatening causes of chest pain will be discussed.  Examples include  ischemia associated with cocaine or OTC/ephedra use,  myocardial infarction in a patient with Kawasaki disease as a child, a dilated aortic aneurysm in a teenager with Marfan’s syndrome, a large pneumothorax, and myocarditis or pericarditis syndromes.

Pediatric Literature Update: Could These Articles Change Your Practice?
1 Hour
Faculty: Richard M. Cantor, MD, FACEP, FAAP
Keeping up with the expanding pediatric emergency medicine literature is quite a challenge for busy emergency physicians. This distinguished expert will review the literature from the past 12 months, focusing on those articles that could affect the way you treat pediatric patients.

Pediatric Sports Concussions: When is it Too Much?
1/2 Hour
Faculty: Chris Koutures, MD, FAAP
Sports concussions are a huge issue in organized sports for children. Evidence is mounting about the deleterious effect of repetitive concussions on memory and the ability to learn. There are conflicting rules about when to return to play, and a lack of adequate testing for post-concussion syndrome by physicians. How can an emergency physician make appropriate recommendations, and stress the need for good follow-up?

Pediatric EM Jeopardy: Test Your Skills
1 1/2 Hours
Faculty: Richard Cantor, MD, FACEP, FAAP
Marianne Gausche-Hill, MD, FACEP, FAAP
Who doesn’t love Jeopardy? Let’s test our collective knowledge in a potpourri of pediatric emergency medicine topics and learn to recognize important radiographic and physical findings vital to the care of children.

Physician Performance and Competence: Ways to Skin the Cat
1/2 Hour
Faculty: Joan Shook, MD, FACEP, FAAP
Joint Commission is now requiring that physician competence be measured at the time of credentialing and recredentialing. This recommendation is based on the knowledge that critical skills in pediatric emergency practice are particularly difficult to maintain because they are exercised infrequently. Measuring and monitoring emergency physician skills is also difficult since we often work alone. How do we know that we have acquired and maintained each of our essential skills in assessment and management of sick and injured children, and how can we prove it to credentialing authorities? What role should we play in developing skill maintenance and demonstration requirements? Techniques will be presented to accomplish these tasks and ensure that our pediatric patients continue to receive optimal care.

Poisons that Kill and Antidotes You Need to Know
1 Hour
Faculty: Milton Tenenbein, MD, FRCPC, FAAP, FAACT, FACMT
Important toxins with potentially life-threatening complications include iron, sulfonylurea, calcium channel blocker, and beta-blocker poisonings. The management of iron poisoning is frequently misunderstood and there are recent advances for specific management of the others that do not appear in standard reference sources. Specific life-saving antidotes that are available for acetaminophen, iron, sulfonylurea and toxic alcohol poisoning will be reviewed by this pediatric toxicology expert.

Recent Advances in the Management of Bronchiolitis and Asthma
1 Hour
Faculty: Richard M. Ruddy, MD
A child presenting to the emergency department with an acute exacerbation of bronchiolitis or asthma is a frequent event with significant implications on resource utilization. There is considerable evidence supporting the rational management of these conditions. A multi-centered study regarding the use of glucocorticoids in bronchiolitis was recently published. Recently, the National Heart Lung and Blood Institute published its new clinical practice guidelines for asthma.  The implications of these brand new data and recommendations for the treatment of bronchiolitis and asthma in children in the emergency department will be reviewed.

Strategies for Managing Dehydration in Children: What’s New?
1/2 Hour
Faculty: David M. Jaffe, MD, FACEP, FAAP
Recently published guidelines have emphasized oral rehydration for children with mild and moderate dehydration 2° to infectious gastroenteritis. Are there circumstances, especially in emergency practice, in which IV hydration is superior or preferred? What is the role of rapid IV infusions to rehdrate a child? These methods will be contrasted and new data comparing the two will be evaluated. The role of anti-emetics also will be discussed.

The Impact of PCR Testing in Pediatric Emergency Care
1/2 Hour
Faculty: Jeffrey Starke, MD, FAAP
Polymerase Chain Reaction (PCR) testing has quickly become an essential tool in medicine for the detection of infectious disease and in identifying genetic disease. The application of PCR testing for identifying life threatening disease in infants and children has expanded to include herpes encephalitis, pertussis, tuberculosis and HIV. PCR testing of the urine for STDs has also improved recognition and treatment. What is the role of PCR test in the emergency care of children? What are the limitations in the use of PCR?

The Toxicology of Hyperthermic Syndromes: When You’re Hot You’re Hot
1/2 Hour
Faculty: Richard M. Cantor, MD, FACEP, FAAP
There is widespread use of polypharmacy in children today. Many drugs, alone or in combination, may present with hyperthermic syndromes (Malignant hyperthermia, Neuroleptic Malignant Syndrome, Stmulants, etc). These life-treatening conditions, their presentation, and their management.

Tweens and Teens: Risks and Challenges in Emergency Practice
1 Hour
Faculty: Jill M. Baren, MD, MBE, FACEP, FAAP
Tweens and teens can be among the most difficult of all emergency patients to care for because of difficulty obtaining a reliable history, child-parent discord, and the need to preserve patient confidentiality while remaining a child advocate. This course will offer practical solutions to very real and difficult issues in this age group such as making the diagnosis of pregnancy, discovering the possibility of sexual abuse, issues related to sexual orientation, or disclosure of suicidal ideation or drug and alcohol use. The important legal information about confidentiality, drug testing, and child protection also will be discussed.

What's New Down Under: Genitourinary Emergencies in Children
1/2 Hour
Faculty: Marianne Gausche-Hill, MD, FACEP, FAAP
Recent advances in genitourinary emergencies include use of clinical scores for selective imaging in patients with scrotal pain, use of topical steroids to treat phimosis, and new techniques for the reduction of paraphimosis and zipper entrapment. Can a negative Color Doppler Ultrasound of the scrotum exclude the need for surgical exploration? What is the role of clinical scores in selective ultrasound imaging of children with suspected testicular torsion? The latest methods and techniques for the treatment of these GU emergencies in children will be addressed.

When the Pump Fails: Case-based Management of Heart Failure in Kids
1 Hour
Faculty: Anthony Chang, MD
There is a myriad of new and exciting options for the management of heart failure in children on the horizon.  Beta-blockers, angiotensin receptor blockers, aldosterone antagonists, and natruritic peptides are becoming popular options for pediatric pump failure. The future of pharmacologic therapy for heart failure may also include newer agents such as calcium sensitizing agents, and drugs that target aspects of the neurohormonal cascade. This case-based review will update the emergency physician on the challenges unique to pediatric patients when translating therapies becoming popular in adults to the special developmental and metabolic needs of children.