Category Archives: PEM Fellow Perspective

The world the Pediatric Emergency Medicine Fellow is quite different from that of the resident or the attending. This column will help us appreciate the unique perspective of the PEM Fellow.

Summertime, and the Kids are Hungry

Author: Danielle L Cullen MD, MPH – Pediatric Emergency Medicine Fellow at Children’s Hospital of Philadelphia

One in five children in the US do not get the food that they need on a daily basis to lead a healthy, active lifestyle. How is it that in a country of wealth and excess, children’s basic needs for life are not being met?

During the academic year, 21.5 million children receive and rely on free and reduced priced school breakfast and lunch as their primary source of nutrition. While summer should be a carefree time of outdoor play, with the absence of school food programs, it is instead too often a time of hunger. Federal Summer Nutrition Programs through the USDA provide meals to children during the summer months. Unfortunately, due to lack of awareness of these programs, they are severely underutilized. Only one in seven children who receive free or reduced-price school meals also participate in summer meal programs.(1) read more

A Case for Ketofol in the Pediatric ED

Imagine it’s a warm day in June when an 18-month old male with a complicated facial laceration involving the oral mucosa from a dog bite presents to your emergency department (ED). His parents are requesting that his lacerations be repaired by a plastic surgeon.   You recognize their concern and are happy to oblige. You want to ensure the best outcome so you decide to do procedural sedation for the repair. You reach for your handy dandy procedural sedation hammer Ketamine. However, while your patient has obviously achieved a dissociative state, he seems to be periodically moving and tongue thrusting. Your consultant is not very pleased at that thought of attempting a delicate repair on a moving child. What can be done? read more

Emergency management of concussion in children: How much rest is too much?

March has arrived and the temperatures in the northeast are rising. With the warm weather come spring and summer sports seasons, and a new batch of concussions in the pediatric and young adult populations. Nearly 4 million sports-related traumatic brain injuries occur each year. The number of children seen in emergency departments for concussion has nearly tripled in the past decade. Over the past 10 years, concussion safety laws have been passed in every state, requiring that children be seen by a medical professional prior to returning to sports. As our awareness of the diagnosis of concussion increases, more and more children will continue to present to emergency departments across the country. read more

Practicing Mindfulness

We have finally recovered from the Big Snow in DC!  I hear another front is approaching, but on significantly smaller scale.

Our PEM fellows attended the DC/MD/VA Regional PEM Fellows conference this fall.  It is an annual event that rotates between the campuses of the Inova Children’s Hospital,  Children’s National and Johns Hopkins University Pediatric Emergency Medicine Fellowship programs covering topics in leadership, teaching and communication.   Dr. Manoj Jain was a featured speaker at the 6th annual conference this past October. read more

Ruminations and Transitions on Life as a PEM Fellow

Life happens.

In a matter of seconds, life can change from one extreme to another.
Some recent examples that come mind are:
A 4-year old boy wearing Superman pajamas, just diagnosed with a brain tumor.
A 9-year old girl who is scared of doctors, diagnosed with acute appendicitis and in need of surgery.
A 12-day old boy with persistent fussiness with HSV meningitis.
A 13-year old girl playing Candy Crush on her iPad with new-onset diabetes.
A 17-year old boy taking a Calculus final exam in school found unconscious. He was in ventricular tachycardia. read more