Tuesday – April 20

9:00 AM – 9:40 AM
12 Steps Into an ER - Combating Micro-Aggressions
Emily A. Rose, MD, FACEP
 
The term “microaggression” has become more well know though it has been around for decades/ It represents intentional or unintentional verbal, nonverbal slights, snubs, or insults to people based solely upon a conscious or unconscious bias. The goal of this discussion is to raise awareness of microaggressions, discuss positive steps that can be taken to manage hidden biases, and reduce their negative effects on workplace decisions and personnel. At the end of this discussion, you should feel more positive that you made the right choice to listen and learn.
 

Objectives:

  • Define what microaggressions are and the negative effects they can have on others
  • Discuss why certain remarks are considered microaggression
  • How to respond to microaggressions in a positive and effective manner
  • What unconscious bias is and how biases can influence workplace decisions and interactions
9:40 AM – 10:20 AM
Anaphylaxis: How to Recognize and How to React
John M. Kelso, MD
 
Anaphylaxis is a common occurrence and presenting complaint in Pediatric EDs today. Multiple publications have highlighted this. They have also pointed out how standardized approaches to management will greatly improve care. The presenter will outline the most important aspects of care.
 

Objectives:

  • Define anaphylaxis
  • Identify the common causes of anaphylaxis (food, drug, stinging insect, latex, exercise-induced)
  • Manage an acute anaphylactic episode
  • Develop recommendations for the future for children who have had an anaphylactic episode
10:20 AM – 11:00 AM
If your “Appy” and you know it – Take It Out or Is It Give Them Meds?
Charles Macias, MD
 
Periumbilical abdominal pain migrating to the right lower quadrant – Yes! Nausea, vomiting, anorexia – Yes! Ultrasound demonstrating noncompressible, blind-ending dilated tubular structure with fluid and fat stranding – Yes! Surgical consultation for appendectomy – Maybe?

Classically a diagnosis of appendicitis resulted in a happy journey down the “yellow brick road” to visit the great and powerful OR. Occasionally when a patient with acute appendicitis was “10,000 Leagues Under the Sea” or “Cast Away” on a desert island medical management with antibiotics was implemented as “the next best” option. Recent studies in both adults and children have now created a fork in the road of appendicitis management – surgical versus medical management.

In this session, data on outcomes of surgical versus medical management for appendicitis will be reviewed with special attention to the unique influence of provider versus patient preference plays in framing the results. Implementation strategies and the role of the Emergency Medicine provider in presenting options for medical versus surgical management will also be discussed. 

Objectives:

  • Outline characteristics of patients studied for medical management of acute uncomplicated appendicitis
  • Describe proposed protocols for medical management of acute appendicitis
  • Review outcomes for surgical versus medical management of acute appendicitis
  • Discuss principles of shared decision making as they apply to the management of acute appendicitis
 
11:00 AM – 11:40 AM 
Cannabis in the Household with Children: A Dangerous Combination
Christian Tomaszewski, MD, MS, MBA, FACEP, FIFEM, FACMT
 
There is growing concern in the US and globally about the risks of cannabis exposure in children. Many of these children once exposed require critical care and intubation. The speaker will illustrate through case presentations the growing crisis of cannabis poisonings in young children and will discuss evaluation and management strategies including addiction teams to assist families with the crisis.
 

Objectives:

  • Describe the increasing number of serious cannabis (THC) exposures in children
  • Discuss when to suspect these poisoning, toxicologic testing, and management strategies
  • Recognize need to involve social services or addiction teams to discuss strategies for reducing future risk of ingestion 
11:40 AM - 12:20 PM
Sepsis in Children: Big Infections in Small Patients
James (Jim) Homme, MD, FACEP
 

Recognition and initial management of children in septic shock is vital for a child’s survival, but it is still quite challenging for the emergency clinician. This expert lecturer will describe the latest guidelines for the recognition and initial management of children presenting with septic shock. Controversies in the use of biomarkers, fluid resuscitation, use of vasopressors, and antibiotic therapy will be discussed.

Objectives:

  • Describe how to recognize pediatric patients with sepsis and septic shock
  • Outline the current strategies to recognize, evaluate, and manage pediatric patients with sepsis
  • Discuss newest guidelines for pediatric sepsis and continued controversies
12:20 PM – 1:00 PM Lunch Break
 
1:00 PM – 1:40 PM
In the Era of COVID-19: The New Normal
Joshua Rocker, MD
 
In 2019 a novel coronavirus was identified in China. By early 2020 it had spread across the globe changing the way we would approach emergency medicine likely forever. Children have for the most part been spared of the ravages of this new disease, however, postinfectious inflammatory complications may occur. This expert speaker will discuss the range of manifestations of COVID-19 in children from acute infections to multi-inflammatory syndromes and most importantly will describe how to screen children in the ED for the most severe of these complications.
 

Objectives:

  • Discuss the range of manifestations of COVID-19 in children
    Define Multi-inflammatory Syndrome in Children (MIS-C)
  • Describe how to distinguish MIS-C from other serious illness in children (e.g., Kawasaki’s Disease, septic shock, myocarditis)
  • Outline laboratory studies that may identify MIS-C and initial stabilization and emergency treatment
1:40 PM – 2:20 PM
Gun Violence and Children: A Penetrating Topic
TBD
 
As emergency medicine providers, we are often at the intersection of the medical and social impact of violence. The penetrating traumatic injuries suffered from ballistics can be horrific and require great skill to initially evaluate and resuscitate. From wound management to damage control resuscitation, lessons learned from the battlefields need to be translated to our large and small Emergency Departments across our country to save injured children. The injuries that these destructive devices render often go beyond the resuscitation room, for both families and providers. The implications of social inequities and desensitization to violence also confound this already complex topic. This course will endeavor to explore this penetrating topic and find ways for us all to heal.
 

Objectives:

  • Describe the unique aspect of specific ballistic patterns of different weapons and how they impact evaluation
  • Discuss emergent management of the children with ballistic wounds
  • Discuss socioeconomic implications of gun violence
  • Discuss the various resources available to help reduce gun violence
2:20 PM – 2:40 PM
Hot or Cold - Searching For the Source of Fever In the Midst Of a Pandemic
Jeffrey R. Avner, MD, FAAP
 

Some version of the hit “viral illness” has held the top spots on the billboards of childhood fever for a couple of decades now. “It’s just a virus” has become the comforting ballad of explanation sung to assuage the febrile fears of caregivers of the well-appearing, fully vaccinated child. Has this changed in the current pandemic? Should it change?

Who should we test and/or treat for “viral” causes of fever? When does “knowing” the virus change management? What about viral co-infection? The focus of this presentation will be to (re)establish a practical, evidence-based approach to fever in healthy, vaccinated children in the midst of a global pandemic. 

Objectives:

  • Acknowledge the impacts that a global pandemic has created on our approach to the febrile child
  • Discuss short term versus long term changes to testing for viral sources of fever in healthy children
  • Describe an evidence-based, individualized approach to fever workup in healthy children
2:40 PM - 3:20 PM
Hot Tots: Decision Rules for Infants Less than 60 Days with Fever
Jeffrey R. Avner, MD, FAAP
 

Fever in an infant <60 days poses challenges for the emergency clinician. Clinical decision rules have been based on data about the risk of bacteremia that no longer apply. New rapid PCR testing for pathogens and data on other biomarkers are now available in the ED. This expert lecturer will describe the latest data on the management of these challenging patients that will change your practice.

Objectives:

  • Discuss risk of bacteremia and serious bacterial infections in infants <60 days
  • Describe the latest published clinical prediction rule and how these data can be incorporated into your evaluation of these patients
  • Outline an algorithm for management of the patients in the ED, when to test, what to test, and which patients to admit

Wednesday – April 21

9:00 AM – 9:40 AM
Literature Review of Pediatric Emergency Medicine
Richard M. Cantor, MD, FACEP
 

Keeping up with the most recent literature addressing current issues in pediatric emergency medical practice can be challenging and time-consuming. The speaker will present the most relevant publications within the past year.

Objectives:

  • Outline the recent research in the field of pediatric emergency medicine
  • Incorporate recent information into one’s practice pattern
  • Demonstrate knowledge of advances in pediatric emergency care in 2020
  • Explain the limitations to recent literature
  • Demonstrate bedside applicability of the recent literature
9:40 AM – 10:20 AM
LVADs: The "I'm Paler"
Mimi Lu, MD, FACEP, FAAP
 

As night falls, the lone patient with the worst medical conditions seem to rise. Are you prepared to manage these patients? LVAD/TH is becoming more common in children and those on the front line will need more than a pitchfork to stave off the dangers associated with them. Join the speaker in understanding the components of the VAD and then the potential problems with structural failure. Explore how to troubleshoot the LVAD with specific guidelines and recommendations. After this course, you will no longer be afraid of the children of the night.

Objectives:

  • Describe components of the VAD and how to assess the proper functioning of a VAD
  • Implement management strategies for patients with VAD
  • Explain the common complications associated with an LVAD
  • Discuss AHA guidelines for cardiac arrest and the modifications required for the VAD patient
10:20 AM – 11:00 AM
Pediatric Radiology Reading Room
Emily MacNeill, MD
 

The speaker will discuss a potpourri of high-yield radiographic findings in pediatrics and patient management when these findings are noted, review don’t miss findings in pediatric radiology, and discuss a manner of looking at films to ensure identification of these findings.

11:00 AM – 11:40 AM
The False Promise of Pediatric Regionalization
Lee Steven Benjamin, MD, FACEP
 
11:40 AM – 12:20 PM Lunch Break 
 
1:00 PM – 1:40 PM
The National Pediatric Readiness Project: How You Can Make a Difference
Marianne Gausche-Hill, MD, FACEP, FAAP, FAEMS
 

The National Pediatric Readiness Project (NPRP) is a national initiative by the American College of Emergency Physicians, the American Academy of Pediatrics, the Emergency Nurses Association, and the Federal Emergency Medical Services for Children Program. The NPRP has been working to improve readiness for care of children in emergency departments since 2009 and is about to launch its second national assessment of emergency departments. The speaker will discuss the publication of the latest guidelines, what impact pediatric readiness has on the care of children, and how all emergency clinicians can impact pediatric readiness in their EDs.

Objectives:

  • Discuss the release of the latest guidelines by ACEP and other stakeholders in the NPRP project
  • Describe the upcoming national assessment in 2020 and how every ED can and should participate (www.pedsready.org)
  • Outline the benefits of improved pediatric readiness and the available evidence demonstrating improved outcomes with high readiness
  • Recognize the opportunities in the gap analysis report for EDs to improve their pediatric readiness
1:40 PM – 2:20 PM
Transgender Patients in the Emergency Department
Emily MacNeill, MD
 

Over 88% of emergency physicians, responding to a survey on care of transgender patients, state that they see these patients in the ED and over 85% have had no formal training in the care of these patients. With an estimated 1.4 million transgender adults in the US it is imperative that emergency clinicians must recognize that this population is at increased risk for poverty, depression, substance abuse, cardiovascular disease and sexually transmitted infections. The speaker will provide best practices for the evaluation and management of these patients in the ED.

Objectives:

  • Define transgender and discuss unique challenges these patients face in the ED
  • Describe best practice for self-identification of name and pronoun without restriction to purely binary male and female designation
  • Outline strategies and protocols staff can initiate that improves the therapeutic relationship for these patients
  • Discuss risk of cardiovascular disease and other conditions which may be impacted by social determinants of health in these patients
2:20 PM – 2:40 PM 
Will They Pay?
TBD
 

As emergency physicians, we see patients, document well, and bill accordingly. But what happens after that bill is submitted? Are emergency services denied entirely? Is the level of admission subject to claim denial? What costs are we translating to patients due to testing or transport? What can we, as EPs do to ensure that we receive appropriate reimbursement and that our costs are not directly translated to patients?

Objectives:

  • Discuss which ED visits may not be covered by insurers
  • Evaluate how insurance standards may impact our decision regarding level of care for admission
  • Discuss regulations that impact our practice and reimbursement
  • Review different transport modalities and the circumstances in which most insurance companies cover air vs ground transport
2:40 PM – 3:20 PM
Resuscitating your Resuscitations a Case-Based Approach
Sean M. Fox, MD, FACEP, FAAP
 

Whether we care for adults, children, or both, we must be resuscitation experts! Fortunately for children, they don’t often require our expertise. Unfortunately, when they do, few people are comfortable with taking the appropriate actions. The presenters will discuss the most current, up-to-date, strategies for pediatric resuscitations to help maximize positive outcomes! Challenging, real cases will be used to highlight the potential pitfalls and elaborate on methods to either avoid the pitfall or get out of it successfully.

Objectives:

  • Discuss methods and strategies to improve the early recognition of the critically ill child
  • Discuss the actions to take during pediatric resuscitations that are known to positively impact outcomes
  • Discuss some of the potential pitfalls of the resuscitation and how to avoid them
On-Demand Courses
 
Pediatric Trauma Pitfalls: Recognize them Before You Fall In
Sean M. Fox, MD, FACEP, FAAP
 

Accidental injuries are the leading cause of morbidity and mortality in the pediatric population. While they are significant, they are also very challenging to manage. The severely traumatized pediatric patient may present differently than the injured adult patient. Providers must be able to account for the difference in presentation accounted for by the variance in anatomy and physiology and how those differences change as the patient’s age changes. The presenter will address these issues and highlight the concerning pitfalls that exist in an effort to help avoid them, if not at least assist us in getting out of them when we fall in.

Objectives:

  • Acknowledge and describe the anatomic physiologic differences that must be accounted for when evaluating a pediatric trauma patient
  • Recognize the common pitfalls, like under-appreciating hemodynamic instability and overlooking blunt cerebrovascular injury and small bowel injury
  • Describe the importance of considering non-accidental trauma as the etiology of the patient’s injuries and how to look for sentinel injuries
Pediatric Chest Pain and Syncope: Simple or Sinister?
Emily A Rose, MD, FACEP
 
Chest pain and syncope in adult patients always garner concern. Fortunately, the same complaint in children is less likely to be due to a significant cause. There are some concerning, severe conditions in pediatric patients, however, that may present with these subtle symptoms. The presenter will review the potentially life-threatening conditions that can cause children to show up in your ED with chest pain or syncope. A reasonable approach to the evaluation of these common complaints will be proposed.
 

Objectives:

  • Discuss the life-threatening conditions that present with chest pain or syncope in pediatric patients
  • Describe a reasonable approach to the evaluation of chest pain or syncope in pediatric patients
  • Recognize the important ECG characteristics that accompany these conditions 
Sprain, Strains, and Separations: Sports Medicine in the Pediatric Emergency Department
Ilene A. Claudius, MD, FACEP
 

We want children to be active, but their activities can lead to injury. Fortunately, these injuries are commonly deemed to be minor, but these minor injuries can still create a major headache for both the patient and the ED provider if not managed well. Sports-related injuries can also be deceptive given the immature skeleton of children. The presenter will discuss the diagnosis and management of common activity-related injuries.

Objectives:

  • Describe the immature skeleton and anatomy that influences common sports-related injuries
  • Identify the appropriate evaluation and management of ankle, knee, elbow, and shoulder injuries
  • Discuss concussion evaluation and return to activity guidelines
  • Review specific types of orthopedic injuries that are fraught with medical-legal issues and how to spot them in the first place
Happy 10th Birthday PECARN Head Injury "Rule" - Oh How You've Grown!
James (Jim) Homme, MD, FACEP
 
It has been 10 years since the publication of the landmark article in Lancet giving us the PECARN Pediatric Head Injury decision rule. In our current era of decision “rules” the focus has been on derivation and validation of highly sensitive rules to identify patients at very low risk for specific injuries or conditions. These rules have been helpful to clinicians to decrease unnecessary testing. However, what about patients who do not meet very low-risk criteria? Are there subgroups within the heterogeneous intermediate-risk category that are higher or lower risk than others? Is there any guidance for providers and caregivers uncertain about imaging or observation? In this session, the presenter will utilize the PECARN Head Injury Study and subsequent publications as a model to highlight how clinical decision rules derived from large multicenter studies can provide important disease/injury prevalence information that can be utilized for further risk stratification of patients presenting with one or more of the identified risk factors in the rule.
 

Objectives:

  • Identify which combinations of risk factors for cTBI that confer a higher risk of injury
  • Identify which individual or combination of risk factors for cTBI confer lower rates of injury that are below thresholds for imaging
  • Recognize low risk of adverse outcomes for patients with minor head injury and negative CT scans
  • Describe a rational approach patients with minor head injury presenting beyond the first 24 hours
Safe Control of the Agitated Patient
Marianne Gausche-Hill, MD, FACEP, FAAP, FAEMS
 

Procedural sedation is often a planned, methodical procedure. What happens when the acutely agitated or violent patient needs sedation – now? In this session, we will discuss the recognition and management of behavioral emergencies requiring chemical restraint, including de-escalation, patient and clinician safety, and practical pharmacopeia.

Objectives:

  • Outline the distinction among behavioral presentations such as willful “acting out” and violence; psychosis; and agitated delirium
  • Describe an approach to recognition, de-escalation, and physical and chemical restraint
  • Discuss the concept of physical and chemical restraint in terms of patient and clinician safety and its practical application
  • Discuss Joint Commission issues 

*Schedule Subject to Change