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Course Descriptions

EMS for Children Program: Thirty Years of Advocacy
8:15 AM - 9:00 AM
Faculty: Elizabeth A. Edgerton, MD, MPH

Emergency Medical Services (EMS) for Children program began thirty-years ago as a project to build the infrastructure for the care of children within existing EMS systems. This expert will describe the Federal EMS for Children Program and the thirty-year journey of advocacy for the care of children. Additionally, accomplishments of the program and its initiatives that affect the care of children in the United States and abroad will be described.

o Describe the development of the EMS for Children program. 
o Discuss the projects sponsored by the EMS for Children projects and its impact on pediatric prehospital and emergency care.

Pediatric Emergency Medical Literature: The Year In Review
9:00 AM - 9:45 AM
Faculty: Richard M. Cantor, MD, FACEP, FAAP

The presenter will provide a concise review of some of the most relevant literature published in the field of pediatric emergency medicine over the past twelve months.

o Demonstrate awareness of the most current research in pediatric emergency medicine.
o Translate new information into clinical practice.

Myths in Wound Care
9:45 AM - 10:15 AM
Faculty: Christopher S. Amato, MD, FACEP, FAAP

Is it okay to clean a wound with tap water? Do I need to irrigate a head or facial wound? Do I really need to wear sterile gloves? Can I use anesthetic with epinephrine on sites with end-arterial blood flow? The speaker will present a comprehensive update on wound care including a discussion of evidence-based literature and how it pertains to the emergency patient. A brief update on animal bite wounds and the use of antibiotic prophylaxis also will be covered.

o Review updates and develop an evidence-based approach to the treatment and care of the wounded/lacerated emergency patient.
o Discuss animal bite wound prophylaxis.

Fever: Time to Abandon Risk Stratification?
10:45 AM - 11:15 AM
Faculty: Jeffrey R. Avner, MD

Fever is one of the most common complaints of children presenting to the emergency department. In most cases, the etiology of the fever is a benign, non-specific viral infection but practitioners are always concerned with the possibility of an underlying serious condition. Various risk stratification strategies have been used to identify those febrile children at risk for serious bacterial illness. Have we reached the point when the incidences of these illnesses are so low that risk stratification is no longer useful? The speaker will cover the declining incidence of serious illness in the post-pneumococcal vaccine era, the efficacy of biomarkers in predicting serious bacterial illness and discussion of appropriate management strategies for febrile young children.

o Define the effect of the pneumococcal vaccine and how it has changed the epidemiology of serious bacterial illness.
o Describe the concern over infections with pneumococcal serotypes not found in current vaccines.
o Define the role of biomarkers as predictors of serious illness.
o Develop an evidence-based approach to the evaluation and management of febrile young children.

Masters of Pediatric EM Expert Panel: Resuscitation Controversies
11:15 AM – 12:15 PM
Faculty: Alfred D. Sacchetti, MD, FACEP (Moderator); Aaron J. Donoghue MD, MSCE; Robert W. Hickey, MD, FAAP, FAHA

The critically ill child has always generated significant concern, even for experienced care providers. Multiple questions and controversies surround resuscitation. How much fluid should I give the patient with severe DKA? Can I use etomidate safely for RSI in the pediatric ED? Should I call the surgeons to get the arresting child on extracorporeal life support? Should I initiate therapeutic hypothermia after I have successfully gotten ROSC? This expert panel will discuss these and some other current controversies pertaining to the management of the critically ill child.

o Discuss the pros and cons of the use of etomidate for RSI in the pediatric ED.
o Discuss a rational approach and fluid management strategy for patients with severe DKA.
o Judge the merits and determine the population that is most likely to benefit from extracorporeal life support.
o Judge the merits and determine the population that is most likely to benefit from therapeutic hypothermia.

Use of Oxygen in Pediatric Resuscitation: Too Much Can be a Bad Thing
1:45 PM - 2:15 PM
Faculty: Robert W. Hickey, MD, FAAP, FAHA

High concentrations of oxygen during resuscitation of neonates and children may result in poor neurological outcomes. In the setting of cardiopulmonary arrest and return of circulation using therapies with high concentrations of oxygen, there are decreased antioxidant defenses that lead to increased oxidative stress and neuronal injury. This speaker will describe the pathophysiology of oxidative stress and provide a practical and evidence-based recommendation for its use in the resuscitation of infants and children.

o Outline the pathophysiology of oxygen in cardiac arrest and describe risk of oxidative stress with continued use post resuscitation.
o Describe current guidelines on the use of oxygen in neonates, infants, children and adolescents in pediatric emergency care.

Keeping your ED Out of the Courtroom: The Medical Legal World of Pediatric EM
2:15 PM - 3:00 PM
Faculty: Steven M. Selbst, MD, FACEP

Pediatric emergency departments are subject to their own set of medical legal risks from more difficult diagnoses in the very young to parents who may have their own agenda. The speaker will review some of the more common medical legal risks encountered when dealing with pediatric patients and their families. Risky complaints such as fever in the young infant or vomiting in the older child will be reviewed.  Clear instructions to lower your ED’s overall risk will be presented. What has been learned from previous medical legal cases involving children in the ED also will be reviewed.

o Explain the unique medical legal risks when dealing with a pediatric patient and their families in the ED.
o Recognize ways and strategies to decrease this risk.
o Describe previous medical legal cases involving children in the ED.

Challenging Cases in Visual Diagnosis
3:30 PM - 4:00 PM
Faculty: Jeffrey R. Avner, MD

Often the clinical impression of a child’s illness is formed on the basis of physical examination findings that are apparent on initial examination. In particular, skin lesions and rashes are common symptoms of both primary disease as well as manifestations of systemic disease. The clinician is frequently faced with the questions: what is causing this rash? Do I need to worry about this? Do I need to hospitalize this child? A potpourri of physical exam findings will be presented in a case-based format. In this way, participants can test themselves on various diagnostic and management issues. This course will provide a quick and effective guide to recognizing and dealing with some challenging pediatric conditions that you may encounter in the emergency department.

o Identify the presenting symptoms of various rashes and skin lesions seen in pediatrics.
o Develop a systematic approach to diagnosing rashes in pediatrics.
o Identify skin manifestations of some systemic diseases.
o Emphasize visual aspects of pediatric diseases.

Health Policy: Let’s Not Forget the Children
4:00 PM - 4:30 PM
Faculty: Michael J. Gerardi, MD, FAAP, FACEP

In the coming months, the United States will see the next step in implementation of the Affordable Care Act. With that, it’s easy to only focus attention on the healthcare of underinsured adults. Millions of children in this country lack health care insurance or have difficulty with access. The speaker will review some of the health policy issues that deal specifically with children as it pertains to the emergency department. How does the Affordable Care Act specifically address improving the healthcare of children? Medicare and private payers are changing how providers will be paid. Does this apply to children? Quality of care delivered is being pushed more than ever before. How does this pertain to children? How does one improve on reimbursement for observation medicine or urgent care medicine for children? Finally, Accountable Care Organizations (ACOs) are the new buzz-word for Medicare health delivery. Does the same concept apply to pediatric patients? The speaker will highlight some of the most current topics when it comes to health policy and children.

o Describe how the Affordable Care Act launching in 2014 applies to children. 
o Explain how the quality delivers might affect your reimbursement for care delivered to children.
o Describe how unique reimbursement issues like observation medicine or urgent cares might apply to children.
o Discuss the new ACO concept and how it might apply to children.

New Approach to Teenaged Gynecology
8:00 AM - 8:30 AM
Faculty: Marina Catallozzi, MD, MSCE

Gynecological complaints in adolescent patients often cause consternation among providers in the pediatric emergency department. Several common diagnoses will be discussed and approaches to these complaints updated: abnormal uterine bleeding, ectopic pregnancy, polycystic ovarian syndrome and ovarian torsion and pelvic pain. Of note, a recent guideline issued by the American College of Obstetrics and Gynecology has clarified the approach to the definition, work-up and management of abnormal uterine bleeding, and will provide the basis for the discussion on this topic. Ectopic pregnancies also deserve discussion as imaging recommendations, the utility of biomarkers both alone and in combination, and treatment approaches are constantly evolving. Finally, as the incidence of polycystic ovarian syndrome increases, the risk for ovarian torsion also increases. The emergency physician must be vigilant to this diagnosis and comfortable with an approach to this important entity.

o Develop an efficient diagnostic approach  to the patient with abnormal uterine bleeding.
o Clarify the therapeutic options for the patient with abnormal uterine bleeding.
o Discuss the biomarkers that have been useful in diagnosing ectopic pregnancy and clarify which imaging techniques are of most value in making the diagnosis of ectopic pregnancy.

Pediatric ECGs
8:30 AM - 9:15 AM
Faculty: Richard A. Friedman, MD

The speaker will begin with a discussion of cardiac physiology and how this changes as a child grows. Emphasis will be on cardiovascular changes at birth and evolving chamber dominance. Subsequent discussion will focus on features of the normal pediatric ECG (axis and intervals) and how this differs from the adult ECG. Interpretation will then follow applying the former topics to displayed ECGs used as examples. A review of ‘abnormal’ ECGs showing common dysrhythmias also will be discussed.

o Discuss cardiovascular physiology as it varies with age from birth to adulthood. 
o Discuss interval and axis changes as it relates to age from birth to adulthood.
o Identify differences in the pediatric ECG in relation to the adult patterns.
o Discuss normal variants and dysrhythmia common in children.

Morsels and More: Online Educational Tools
9:15 AM - 9:45 AM
Faculty: Sean M. Fox, MD

The informational highway is getting faster every day. Staying on top of the most current topics and controversies is becoming increasingly difficult. While textbooks are invaluable resources, their materials are dated. Even current journal articles can be yesterday’s news. How can a physician utilize the technologies that are available to stay abreast of the most up-to-date information? The speaker will cover useful electronic resources that can be tailored to the individual’s needs and desires. How to avoid the feared informational-overload also will be discussed.

o Identify useful online resources (blogs, educational sites, etc.) that will assist you in staying up to date with pediatric EM topics.
o Discuss beneficial strategies to deliver this useful content in an organized fashion and avoid informational-overload.

Post-Op Heart: When to Worry
10:15 AM – 11:00 AM
Faculty: Richard A. Friedman, MD

The speaker will begin with a discussion of common interventions and surgical approaches, including devices used in the post-operative period (common surgical drains, external and internal pacers and wire placement). The discussion will then shift towards likely complications during the acute period following surgery focusing on the likely scenarios presented to the emergency physician in the emergency department setting. Complications will be broken down by groups of infectious, acute dysrhythmia and hemodynamic disease such as cardiac dysfunction, altered flow and thrombus formation.

o Discuss cardiac physiology and common surgical technique and approaches.
o Identify immediate post-operative complications including pacing and dysrhythmia.
o Discuss ongoing management strategy, echocardiographic assessment, and angiographic studies.
o Identify delayed post-operative complications.

Controversies in the Management of Pneumonia in Children
11:00 AM - 11:45 AM
Faculty: Jeffrey R. Avner, MD

Pneumonia is a common condition in children presenting to the emergency department. Recent Infectious Disease Society of America guidelines outline the evaluation, diagnostic testing and management of these patients. Controversial issues such as when infants and children can be safely discharged from the ED, treatment of effusions, and targeted empirical antibiotic treatment while minimizing future antibiotic resistance will be discussed. When you should suspect TB or pertussis instead of community-acquired pneumonia also will be discussed.

o Discuss the latest guidelines for management of children with pneumonia as proposed by the Infectious Disease Society of America.
o Apply these guidelines in context to pediatric emergency care, using case scenarios .
o Describe controversies in diagnosis and management of pneumonia including when to admit, who can you safely discharge, and use of empiric antibiotic agents.

The Newest Drugs of Abuse: Ever Changing Ever Challenging
11:45 AM - 12:30 PM
Faculty: Christine M. Stork, PharmD, DABAT, FAACT

Using a case-based format, the presenter will provide critical case scenarios representing the most current abusive drug toxidromes.

o Develop awareness of the most currently abused drugs.
o Recognize their clinical presentations.
o Adequately manage the new overdoses.

Ketamine Analgesia: New Use for an Old Drug?
2:00 PM - 2:30 PM
Faculty: James Homme, MD

Ketamine is widely known as a dissociative anesthetic agent and is arguably “king” in the world of pediatric procedural sedation in the emergency department due to its efficacy and safety profile. Increasingly ketamine is turned to as a near ideal induction agent for rapid sequence intubation in tenuous hemodynamic situations such as trauma or sepsis. Myths of ketamine’s contraindication in traumatic head injury or increased intraocular pressure have all but fallen into legend. Surely the emergency medicine applications of this “old drug” have been exhausted – or have they? The speaker will discuss the role of ketamine in the pediatric ED in 2014!

o List the properties of ketamine that make it an excellent agent for potent analgesia.
o Identify clinical situations and settings where ketamine may work as an adjuvant analgesic agent.
o Calculate bolus and drip doses of ketamine for analgesia in the prehospital and emergency department settings.
o Safely utilize ketamine in the ED separate from the common role it plays in procedural sedation.

Black Box Drugs and Other Controversies: Reality of Use in the ED
2:30 PM - 3:15 PM
Faculty: Christine M. Stork, PharmD, DABAT, FAACT

Pharmacogenetics, QT prolongation, and black box warnings - OH MY! These words can create nausea, headaches or promote intense agitation and confusion amongst clinicians caring for children in the emergency department. Increasingly they are influencing the daily practice of medication selection. Are there some medications that are commonplace in the pediatric ED that should be permanently shelved and others that really should be brought back? What about off-label use of medications that seem to have a long track record of safety but no FDA approval for our patients? The presenter will discuss some of these controversial medications such as codeine, droperidol, dexamethasone, and fluoroquinolones, and how they may either promote or aid in alleviation of some of our commonly encountered problems in the ED.

o Describe the rationale for the black box warning recently placed on codeine for post-op tonsillectomy/adenoidectomy.
o List alternative opioid analgesics to codeine for pain control and compare safety and efficacy of these medications to codeine.
o Report the various applications for droperidol utilization in the pediatric patient.

Up the Nose: Not Only for Fingers and Foreign Bodies-Intranasal Medication Applications in Pediatric EM
3:45 PM - 4:15 PM
Faculty: James Homme, MD

Children have an uncanny sense of the practicality of the nose as a place to find a quick snack or as a storehouse for any number of interesting items. Savvy pediatric practitioners have started to take a cue from their patients and recognize that the nose is also an excellent medication destination. Many of our commonly utilized drugs can be delivered efficiently utilizing mucosal atomizing devices (MADs) resulting in rapid onset of therapeutic levels in the systemic circulatory and central nervous system through the highly vascular nasal mucosa—approaching rates close to intravenous (IV) administration without the delay or distress of IV insertion. Curr

o Describe the properties of the nose that make it an effective and even preferable location for medication delivery.
o Utilize tricks and techniques for intranasal medication administration.
o List effective medications for treatment of pain, anxiety, seizures, and procedural sedation with excellent intranasal applications.
o Calculate appropriate doses and volumes for intranasal medications.

ALTE Update: Common Sense Approach to the Latest Clinical Decision Rules
4:15 PM – 4:45 PM
Faculty: Manoj Mittal, MD, MPH

Apparent life-threatening events (ALTE) presenting in children requires careful evaluation and often admission. There have been several proposed clinical decision rules to allow for safe discharge from the emergency department for selected infants. Can this be done safely? What are the risks of such strategies? The speaker will discuss the issues related to care of children with ALTE, and using the latest evidence, propose recommendations for safe discharge, and when to admit for critical care.

o Discuss the latest clinical decision rules on admission of ALTE patients and need for critical care.
o Describe the pros and cons as well as safety of discharge for selected infants with ALTE.

I Didn’t Get That: Handoffs in the Pediatric ED
8:00 AM - 8:30 AM
Faculty: Kathy N. Shaw, MD

As health care reform drives more accountability for outcomes, errors in handoffs have had a more profound impact for outcomes in pediatric care. This session will focus on the strategies in handoffs at shift change. Current literature will be described, problems and impact in handoffs will be delineated, and ways to improve outcomes from structured handoffs between providers will be discussed.

o Discuss the gaps in situational awareness and safety threats during handoffs of pediatric patients in the ED.
o Define potential safety errors in handoffs with attention to the scope, impact, and potential liability from errors in handoffs.
o Explore strategies for improving communication during handoffs.
o Describe the role of the AAP Handoff Collaborative.

Sleeping With The Enemy? Expectations and Reality in Imaging Children in the Emergency Setting
8:30 AM – 9:15 AM
Faculty: Nancy A. Chauvin, MD; Kathy N. Shaw, MD

The Imaging Gently Campaign and the emphasis on the ALARA principle have had an impact on pediatric emergency care. With over 1.6 million visits to the ED involving CT imaging in children there is a critical need for strategies to reduce radiation exposure in children. During this point/counterpoint discussion, practical and achievable strategies used by radiology and pediatric emergency practitioners that result in an evidence-based approach to diagnostic imaging and are consistent with the Imaging Gently Campaign will be discussed.

o Describe current knowledge on radiation risk for children from CT imaging and define the ALARA principle as it relates to pediatric emergency care.
o Discuss the Imaging Gently Campaign and its impact on pediatric emergency care.
o Outline evidence-based strategies to reduce radiation exposure from diagnostic imaging to include protocols by radiologists and evidence-based guidelines for when to CT image for children with suspected appendicitis, c-spine injury, minor head injury, and

Management of the Difficult Airway in Children: Latest Gadgets and Tricks of the Trade
9:15 AM  - 10:00 AM
Faculty: Marianne Gausche-Hill, MD, FACEP, FAAP

Managing a difficult airway in children is a daunting task. First the emergency physician needs to recognize patients at risk and identify when a difficult airway presents. This expert will describe recognition and management of the difficult airway, describe what types of adjuncts or devices should be in a difficult airway kit/cart in the ED, and problem solve case studies in airway management.

o Define the difficult airway in pediatrics and conditions that predispose to challenging airway management.
o Contrast and compare adult strategies to identify and manage the airway with those seen in pediatrics and offer practical solutions for management.
o Describe the latest devices for airway management in children and how they may be used in a difficult airway scenario.
o Outline must haves and optional items for a difficult airway cart/kit for the ED.

Critical Findings in Pediatric Radiology: Part 1
10:15 AM – 11:00 AM
Faculty: Nancy A. Chauvin, MD

Radiology is an important component of pediatric emergency medicine. Caregivers need to be able to identify both obvious and subtle radiologic signs that herald the possibility of serious illness. The presenter will provide a review in a case-based format.

o Demonstrate awareness of subtle radiologic findings in the pediatric emergency patient.
o Translate these findings into appropriate management plans.

Using Capnography in Pediatric Emergency Patients: Traditional and Nontraditional Uses of ETCO2
11:00 AM  - 11:45 AM
Faculty: Aaron J. Donoghue MD, MSCE

Use of end-tidal CO2 monitoring has become the standard in many EDs for the care of children in specific clinical settings including RSI and intubation confirmation, sedation and analgesia, and in monitoring during cardiac arrest resuscitation. This expert will describe devices and the procedure for use of waveform capnography in the ED. Case scenarios will highlight specific indications for its use and some of the issues in obtaining accurate readings. Alternate uses such as ETCO2 levels as a measure of dehydration or severity of DKA also will be discussed.

o Discuss the latest guidelines for use of ETCO2 in the ED for children.
o Provide examples of indications and practical application of this technology using case scenarios.
o Describe issues in obtaining accurate readings and troubleshoot these scenarios.
o Outline some nontraditional uses of ETCO2 such as assessing for dehydration and monitoring treatment success in DKA patients.

Critical Findings in Pediatric Radiology: Part 2
11:45 AM - 12:30 PM
Faculty: Nancy A. Chauvin, MD

Radiology is an important component of pediatric emergency medicine. Caregivers need to be able to identify both obvious and subtle radiologic signs that herald the possibility of serious illness. The presenter will provide the second part of this review in a case-based format.

o Demonstrate awareness of subtle radiologic findings in the pediatric emergency patient.
o Translate these findings into appropriate management plans.


©  2014 American College of Emergency Physicians