All posts by Lindsay Peters

2nd place Emage Winner: Subgaleal Hematoma beyond the neonatal period

Deepak Choudhary, MBBS, MRCPCH, MD;  Sarah Dipalma, MD; Jessica Strauss, MD; Mary Emborsky, MD; Frank Carnevale, MD

Department of Pediatric Emergency Medicine, Oishei Children’s Hospital, University of Buffalo, New York

A four-year-old African American female presented to our ED with one day history of bogginess of her scalp. The guardian mentioned there were two unwitnessed falls from a trampoline and bunk bed in the last two days. The family denied behavior changes, headache, neck pain, vomiting, numbness or weakness. No bleeding problems were reported by the child or family. read more

1st Place EMage Winner: A Case of the Venomous Arthropod: A Purple Toe?

Dacia J. Ticas, MD;  Cristina M. Zeretzke-Bien, MD

University of Florida College of Medicine, Department of Pediatric Emergency Medicine, UF Health, Gainesville, Florida

A 13-year-old female presented to an outside emergency room (ED) one day prior with a chief complaint of her left great toe turning purple. She denied any weakness or tingling, any shoe tightness, rubbing, or blistering. She presented to the ED again however as symptoms had not improved. The physical exam was only notable for the left great toes’ plantar surface was a deep hue of purple and black. The toe was non-tender, and was not fluctuant or with increased warmth.  The foot and toes had intact sensory and motor function. The dorsal aspect of the foot was unaffected and had an intact nail and nailbed without any visible trauma.  Pulses were palpable. read more


Author: Kathleen Brown, MD – Children’s National Health System

The Federal Emergency Medical Services for Children (EMSC) Program recently released an infographic based on data from the National Pediatric Readiness Project assessment. The infographic states the importance of weighing children and recording the weight in kilograms, based on a patient safety recommendation from the “Guidelines for Care of Children in the Emergency Department.1

In its report Emergency Care for Children: Growing Pains, the Institute of Medicine also highlighted the need for physicians and other practitioners to weigh children and to record the weight in kilograms only.2 However, the Pediatric Readiness assessment revealed that half the hospitals in the nation do not weigh and record in kilograms. This simple patient safely initiative has been recognized as one of the most important to prevent drug-dosing errors and is one of the top 15 national hospital-based pediatric emergency care performance measures.3 read more

Medical Training & Physician Wellness: No More Drowning

Recent studies have shed light on a concerning trend among physicians in-training:   un-wellness.  This is manifest in increased burnout, depression and suicide rates seen among those undergoing medical training when compared to other professions. This crisis becomes cyclic when physicians with low baseline levels of wellness are unable to give optimal patient care, which in turn detrimentally influences their poor levels of wellness.  Historically physician wellness has not been a focus of medical training.  New endeavors are hampered by inadequate structure, funding and resources.

How can we learn how to swim when we are already drowning?

Governing bodies, professional associations, training programs and individual fellows and residents have all recognized the need for change.  Each entity has a unique responsibility and an exciting opportunity help transition us from surviving to thriving.

Let’s learn how to swim.

The ACGME is the governing body that provides a national standard for graduate medical education and validated measuring tools for the evaluation of our programs and trainees. They have built strategies for the ideal learning environment, which include increased awareness of depression, formal mentor programs and official wellness curriculums. These recommendations provide consistent methods for medical education to utilize for the improvement of wellness.

Professional associations such as ACEP offer many educational opportunity, resources and forums that allow members to discuss and share ideas on how to improve wellness within a specific specialty.  Training programs apply the national and professional standards to the individualized need of the trainees and the resources available to the program.

Individual fellow and resident investment in their personal wellness is vital. Awareness of individual and colleague wellness is the first step in finding a solution.  The next step is utilizing the various resources available. Lastly, commitment to ongoing individual care including personal outlets such as physical activity, spirituality, creativity, nutrition and restoration are invaluable to help achieve the wellness that we all desire.

Coordinated sustained practice will help us swim in stormy waters

Physician wellness is a multi-dimensional problem; and thus cannot be fixed by one-dimensional solutions.  Collaboration of each entity listed above is vital to the success of improved wellness. We must continue to transition from a mindset of burnout and fatigue recovery to conservation of wellness.

For more information:

ACEP Wellness:


Stephanie Moses, DO

Clinical Instructor in Pediatrics

Northeast Ohio Medical University

PEM Fellow, PGY5

Division of Emergency Services

Akron Children’s Hospital


Esther Lutes, MD,

Associate Professor Pediatrics & Emergency Medicine

Northeast Ohio Medical University

Associate Fellowship Director, Pediatric Emergency Medicine

Division of Emergency Services

Akron Children’s Hospital


Author: Kathleen Brown, MD – Children’s National Health System

In April 2015, the first manuscript addressing key findings from the 2013-14 National Pediatric Readiness (Peds Ready) assessment was published online in JAMA Pediatrics. A few important data points highlighted in the article included:

  • The presence of a physician and nurse pediatric emergency care coordinator (PECC) was associated with a higher adjusted median Pediatric Readiness score compare with no PECC.
  • read more