Monday – March 18

 
8:00 AM – 8:30 AM
Pediatric ENT Foreign Bodies
Sean M. Fox, MD, FACEP, FAAP
 
Children do find a way to put unusual objects in the strangest of places. Ears, noses, and throats may seem like a good place to hide a toy at first, but then they can cause a fair amount of discomfort and distress. Having a strategic approach to each of these clinical scenarios can make your ED shift less problematic. The presenter will cover the current literature, techniques, and best practices to efficiently and safely manage ENT foreign bodies.

 

8:30 AM – 9:00 AM
Airway Tricks of the Trade
Marianne Gausche-Hill, MD, FACEP, FAAP, FAEMS
 
Management of the pediatric airway can be a challenge as the approach changes with the age of the child. The speaker will present the “tricks of the trade” and provide tools that will assist the emergency clinician in pediatric airway management. Current strategies and controversies will be discussed including determining endotracheal tube size, use of video laryngoscopy in intubation, RSI medications, use of high flow nasal oxygen during RSI, and various airway alternatives including supraglottic airways.

 

9:00 AM – 9:30 AM
DKA Like a Boss
Kathy N. Shaw, MD, MSCE, FAAP
 
Diabetic ketoacidosis (DKA) is the most frequently encountered endocrine emergency in pediatrics. Up to 30-50 percent of pediatric patients with a new diagnosis of diabetes mellitus present in DKA. Patients present with a spectrum of hyperglycemia, volume contraction, acidosis from bicarbonate loss and ketoacidosis production and electrolyte abnormalities. 0.5-1 percent of patients will present with or develop increased intracranial pressure and severe neurologic dysfunction or death. As clinicians are there actions that we perform which either improve or worsen outcomes in these patients? The presenter will review the latest evidence in pediatric DKA management including rate of fluid resuscitation, insulin administration, electrolyte repletion, role of bicarbonate for acidosis, intensity of monitoring and interventions for cerebral edema.

 

9:30 AM – 10:00 AM
Shock Recognition and First Steps
Christopher S. Amato, MD, FACEP, FAAP
 
Tachycardia is to be expected but hypotension is deadly! Children generally have more favorable outcomes when critically ill as compared to an adult patient. The one thing they do NOT do well with is provide large enough veins for rapid access. Rapid recognition of the child in extremis is key to saving their life and vascular access with appropriately resuscitation is the first and MOST crucial step. Using the latest literature, a case-based presentation will discuss the main causes of shock , basic and advanced access, and the current literature-based guidelines for the approach to treatment.

 

10:00 AM – 10:15 AM – Break
 
10:15 AM – 11:00 AM
Fever in 2019
Marianne Gausche-Hill, MD, FACEP, FAAP, FAEMS
 
One of the most common reasons for a child to visit an emergency department is a fever. Is it “ just a virus” or something more? What is the best approach to assessment by age category—infant, pre-school, school age, adolescent? This expert will discuss the ever changing approach to fever in the pediatric emergency department based on lasted evidence and published guidelines.

 

11:00 AM – 11:30 AM
Pediatric Major Trauma: Priorities and Perspective
Sean M. Fox, MD, FACEP, FAAP
 
Traumatic injuries are still the leading cause of morbidity and mortality in the pediatric population. Being facile and adept at the assessment and management of children presenting after traumatic events is unquestionably important. In order to deliver excellent care to this children, it is critical that the pediatric anatomic and physiologic differences compared to adults be understood. Additionally, knowledge of the current literature will help distinguish which patients may not benefit for advanced imaging. The presenter to discuss how to approach these challenging cases to ensure potential hazards are avoided.

 

11:30 AM – 12:00 PM
Minor Head Trauma: PECARN Pitfalls
Kathy N. Shaw, MD, MSCE, FAAP
 
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 on patients who meet criteria. The PECARN Minor Head Injury rule is an excellent example such a tool of a 1-way rule where patients who meet all criteria for the rule can be safely excluded from further investigation. However, what is a practitioner to do with patients who do not meet low-risk criteria (i.e. are not rule negative). Does the “rule” have anything else to offer? What if the patient presents with isolated vomiting or loss of consciousness and vomiting? Is their risk of a clinically important traumatic brain injury (cTBI) or TBI on head CT the same as someone with severe mechanism of injury only or a significant headache? How about if a CT scan is performed – is there information within the larger study to provide guidance on disposition of the patient?
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 which can be utilized for further risk stratification of patients presenting with one or more of the identified risk factors in the rule.

 

12:00 PM – 1:00 PM – Lunch – On Your Own

 

1:00 PM – 1:30 PM
Status Asthmaticus
Christopher S. Amato, MD, FACEP, FAAP
 
“Not all that wheezes is asthma” and what’s worse? – hearing wheezes or hearing nothing? Management can be altered based on prior practice or even local standards but the presenter will discuss the evidence-based approach to the assessment and management of the child who presents with status asthmaticus. This is not “cookie-cutter” medicine but a presentation of the optimal management of status asthmaticus using best-practices. Research and suggestions of likely cutting-edge practice will be discussed such as starting inhaled therapy in the ED. Discuss first and second line therapy principles of management for status asthmaticus.

 

1:30 PM – 2:00 PM
Respiratory Distress: An Evidence-Based Approach
Sean M. Fox, MD, FACEP, FAAP
 
Respiratory distress is one of the most common presenting complaints seen in children presenting to our EDs. Sometimes it seems as if every child is wheezing. With this in mind, being proficient at the evaluation and management of these children is critical. Additionally, resisting the complacency that comes with managing these commonly encountered conditions is vital. After all, “not all that wheezes is asthma.” With this in mind, the presenter will discuss the evidence-based approach to the assessment and management of the child who presents with respiratory distress.

 

2:00 PM – 2:30 PM
Status Epilepticus
Mohsen Saidinejad, MD, MBA, FACEP, FAAP
 
A 2-year-old girl is brought to ED in status epilepticus. What are management strategies after the use of benzodiazepines? What should be the second line agent? When is airway management needed? The speaker will discuss the latest evidence for the management of infants and children in status epilepticus.

 

2:30 PM – 3:00 PM
The Last Rash
James (Jim) Homme, MD, FACEP
 
Sick or not sick? Life-threatening or not? Can we be sure that this won't be the patient's last rash? Learn about the pitfalls of dangerous rash evaluation.
 

 3:00 PM – 3:15 PM – Break – Visit the Exhibits and Learning Lounge

 

3:15 PM – 3:45 PM 
Ortho Puzzlers
Christopher S. Amato, MD, FACEP, FAAP
 
Traumatic injuries are one of the most common presenting complaints in the ED and children are active! Kids are NOT small adults (it had to be said) so there are anatomic and physiologic differences compared to adults. From apex to ankle the speaker will review those injuries that are not as straightforward as you may initially believe and how to approach these challenging cases to ensure that any potential puzzles are solved.

 

3:45 PM – 4:15 PM
The Sick Neonate
Ilene A Claudius, MD, FACEP
 
Very little strikes fear in the heart of the emergency provider more than a neonate. Assessment of these little creatures may prove challenging to the most experienced clinician. Neonatal respiratory distress may be caused by infectious, cardiac, metabolic, or benign etiologies. Deadly conditions initially may appear benign. Developing an awareness of subtle but fatal diagnoses is vital to emergency physicians. It is important that the emergency clinician is aware of the key neonatal deadly diagnoses where early intervention can dramatically reduce morbidity and mortality.

 

4:15 PM – 4:45 PM
Antidotes You Need to Know
Richard Cantor, MD, FACEP, FAAP
 
“Supportive care” may lull you into a false sense of security in poisonings. When a toxin has a viable antidote, you better know how and when to use it! Attend this course to learn what you need to do before you leave the bedside.

 

4:45 PM – 5:15 PM
Constipation and Its Evil Siblings
Mohsen Saidinejad, MD, MBA, FACEP, FAAP
 
Constipation is a common scourge, but it can be a common “cop-out” as well. Come learn some dangerous conditions that can masquerade as constipation, co-exist with it, or be a complication of it. Not all that withholds is stool. Don’t be fooled.

 

*Schedule Subject to Change