21 | Submersion Injuries with Dr. Sarah Lazarus

In this episode of PEM CHATT, host Toni Dobson is joined by pediatric emergency physician Dr. Sarah Lazarus to break down the critical topic of pediatric drowning and submersion injuries. Together, they explore real-world clinical scenarios, debunk common myths, and provide practical guidance for both clinicians and caregivers.

Drowning remains one of the leading causes of death in children, particularly ages 1–4, and even non-fatal events can result in devastating long-term consequences. This episode emphasizes both clinical management and prevention strategies—highlighting how quickly these events occur and how often they happen despite close supervision.

🔑 Key Takeaways

• Drowning is fast and silent
  • Often occurs in seconds with little to no splashing or noise
• Terminology matters
  • “Dry drowning” and “secondary drowning” are outdated and misleading
• Pathophysiology is respiratory
  • Water aspiration → surfactant washout → impaired gas exchange → hypoxia
• Observation is critical
  • True aspiration events should be monitored for ~6 hours from the time of incident
• Imaging isn’t always helpful
  • Chest X-rays can lead to unnecessary admissions without changing outcomes
• Management is symptom-driven
  • Asymptomatic → observe
  • Symptomatic → oxygen support, VBG, imaging, admission
• Cardiac arrest cases are severe
  • Focus on oxygenation, ventilation, rewarming, and consider ECMO early
• Prevention requires layers
  • No single strategy (including swim lessons) is sufficient

⚠️ Clinical Pearls

• Drowning is an evolving process, not a single moment event
• Patients should be observed for 6 hours after the event
• Symptoms appearing days later are NOT due to drowning
• Pediatric arrests are often respiratory in origin → prioritize ventilation
• Antibiotics and steroids are not routinely indicated
• Most toddler submersion injuries do NOT require C-spine immobilization

🧠 Myth Busting

“Dry drowning” isn’t real. This term originated from outdated medical concepts but is no longer used. If a child had a true submersion injury, symptoms will present within 6 hours—not days later.

🛟 Prevention Insights

• Use “arms reach, eyes reach” supervision
• Perform a home swim test (can the child swim 2 pool lengths?)
• Understand that:
  • Swim lessons ≠ drowning proof
  • Life jackets ≠ guaranteed safety
• Drowning prevention requires multiple overlapping layers of safety

Resources and references:

• Brenner’s article: https://pubmed.ncbi.nlm.nih.gov/19255386/
• CHOA Algorithm: https://www.choa.org/-/media/Files/Childrens/medical-professionals/clinical-practice-guidelines/submersion-event-ed.pdf
• NEJM Article: https://www.nejm.org/doi/full/10.1056/NEJMra1013317#figures_media

Timeline

00:00 Welcome to PEM CHATT

00:19 Why Drowning Matters

01:12 Meet Dr. Sarah Lazarus

02:14 Bread Pudding is my favorite

03:34 Drowning Terminology

04:38 Who Is Most at Risk

06:08 Silent Drowning Explained

09:15 Systemic Effects Checklist

11:03 Fresh vs Salt vs Cold

11:46 Three Patient Categories

12:36 Case One Asymptomatic Kid

14:12 Avoiding Unneeded X-Rays

16:12 Case Two Symptomatic Infant

18:40 Imaging and Labs Strategy

18:58 When to Skip Antibiotics

20:02 Arrest Scenario Walkthrough

20:30 Resuscitation Priorities And ECMO

21:54 When Resuscitation Is Futile

22:40 C-Spine Immobilization Debate

23:24 Drowning CPR Starts with Breaths

25:29 Injury Prevention Work and Stats

27:14 Layers of Drowning Prevention

30:01 Dry Drowning Myth Busting

33:16 Key Pearls and Closing

In this “Rewind” episode, Toni sits down with retired pediatrician Dr. Margaret “Meg” Wang, who trained and practiced through the pre-vaccine and early-vaccine eras of pediatrics, including the 1989–1990 measles epidemic in New York City. Together, they walk us through what pediatrics looked like before Hib, pneumococcal, varicella, and rotavirus vaccines and what we might face again as vaccination rates fall and herd immunity wanes.

You’ll hear vivid, frontline stories of:

• Hib meningitis, occult bacteremia, and epiglottitis in infants and toddlers, when full sepsis workups (blood, urine, CSF, IV antibiotics, 72-hr admissions) were standard for many febrile children through 36 months of age.
• “Old-school” periorbital and buccal cellulitis from Hib—bright red with a violaceous hue, toxic kids, high fevers, and automatic LP + admission.
• Measles in an actual epidemic: the prodrome with the “three Cs” (cough, coryza, conjunctivitis), Koplik spots, and that classic confluent, head-to-toe rash, plus why measles is not a mild illness.
• Varicella beyond the “nuisance rash”: super-itchy multi-stage lesions, serious skin infections, and a child who developed Staph aureus bacteremia and tricuspid valve endocarditis requiring open-heart surgery—all from chickenpox in an unvaccinated child.
• Rotavirus winters: the green, watery, diaper-filling diarrhea, relentless fluid losses, metabolic acidosis, hypoglycemia in infants, and frequent admissions—versus the near-disappearance of severe rotavirus disease after the vaccine.

Clinically, Toni and Dr. Wang dig into:

• How fever protocols for 0–36 month-olds have evolved from routine full sepsis workups to today’s more nuanced approach with viral testing and inflammatory markers like CRP and procalcitonin.
• Bedside pattern recognition for epiglottitis (toxic, drooling, tripod positioning, chin thrust, neck extension) and why you never upset these kids or put a tongue blade in their mouth—just get them upright and straight to controlled intubation with anesthesia.
• The role of parental gut instinct and why “this is not my kid” should always make you pause and reassess.

🔑 Key Takeaways:

• Vaccines didn’t just reduce visit volumes; they completely changed inpatient and ED workflows, procedure rates (LPs!), and long-term morbidity (e.g., deafness after meningitis).
• As coverage declines, we won’t just see “more fevers”—we’ll see sicker kids, more invasive procedures, more admissions, and more preventable complications.
• Your vaccine counseling today is part of preventing tomorrow’s “Rewind” from becoming reality again.

📌 Call to Action:

Hit play, then share this episode with a colleague, resident, or trainee who has never seen these diseases and thinks of measles or chickenpox as “mild.” Their future patients are counting on it. 💉🧠

Fever Management in Children 3-36 Months: An Evidence-Based Approach

Join host Toni Dobson and guest Andrea Perkins, PA-C, as they dive deep into the evidence-based management of fever in otherwise healthy children aged 3-36 months. This comprehensive episode covers everything from basic fever physiology to algorithmic approaches for both vaccinated and unvaccinated children.

Key Topics Covered:

Defining fever and understanding the pathophysiology

The critical difference between fever and hyperthermia

Vaccination status and risk stratification

Comprehensive physical exam pearls

Evidence-based algorithms for immunized vs. unimmunized children

UTI risk assessment and when to obtain urine samples

Laboratory workup guidelines based on vaccination status

Fever management strategies and parent education

Addressing fever phobia in families

Resources:

UTI Calculator: www.uticalc.com

UpToDate management guidelines: UpToDate Link

Andrea's algorithm: Link to Algorithm

Next Episode: Dr. Margaret Wang joins us to discuss the return of vaccine-preventable illnesses and how we can prepare.

📺YouTube: https://www.youtube.com/@PEMChatt

🟢Spotify: https://open.spotify.com/show/6oaYDeq5AXIZGxBvEIxaTs

🍎 Apple Podcasts: https://podcasts.apple.com/us/podcast/pem-chatt/id1806882767

In this episode of PEM CHATT, the focus is on febrile neonates, the first part of a two-part series on pediatric fever management. Host Toni speaks with Dr. Lindsay McHale, a pediatric emergency medicine physician, to discuss how historical protocols for managing febrile neonates have evolved with advances in vaccines, PCR testing, and maternal surveillance. The discussion covers the 2021 AAP guidelines for managing febrile neonates, the essential components of a fever workup, interpretation of test results, and the nuances of decision-making across neonatal age groups. Practical insights on performing lumbar punctures, antibiotic selection, and interpreting potentially confounding results, such as bloody CSF taps, are shared, along with real-life case examples that illustrate the complexities involved. The conversation aims to equip clinicians with an evidence-based approach to improve patient outcomes in various clinical settings.

#PEM #NP #APP #PA #pediatrics #emergencymedicine #emergencynursepractitioner #fellowship #medicaleducation #podcast #children #nursepractitioner #clinicalpharmacists #febrileneonate #sickbabies #lumbarpuncture

00:00 Introduction to Febrile Neonates

00:57 Historical Management of Febrile Neonates

01:25 Advancements in Medicine and New Guidelines

02:23 Introducing Dr. Lindsay McHale

03:56 Defining Febrile Neonates

04:54 Managing Febrile Neonates in the ER

05:51 Cold Babies and Controversies

07:45 Treating Fever in Neonates

09:06 Inclusion and Exclusion Criteria for Febrile Neonate Protocol

10:27 Why Neonates Are High-Risk

11:40 Code 60: Rapid Response for Febrile Neonates

12:30 Hypothetical Case Study: Febrile Neonate

14:24 Parental Concerns and Communication

19:57 Detailed Workup and Testing

23:27 Antibiotic Choices for Neonates

25:13 Dosing Nuances in Neonatal Antibiotics

26:49 Tips for Performing Lumbar Punctures

30:25 Interpreting Test Results in Neonates

32:46 AAP Sepsis Protocol for Neonates

40:06 Managing Febrile Infants: Case Studies

44:18 Conclusion and Next Episode Preview

LINKS:

AAP Guideline https://publications.aap.org/pediatrics/article/148/2/e2021052228/179783/Evaluation-and-Management-of-Well-Appearing?autologincheck=redirected

CHOP Algorithm

https://www.chop.edu/clinical-pathway/febrile-infant-emergent-evaluation-clinical-pathway

THE MISFITS

https://drive.google.com/file/d/1gpUsQOxMlbuqI-6hBDcZEF5ckpJWhWWb/view?usp=sharing

🩺 Essential Medications in Pediatric Emergency Medicine - In-Depth Discussion with Clinical Pharmacists, Mager Raker and Morgan Padron 💊

In this episode of PEM CHATT 🎙️, host Toni Dobson is joined by clinical pharmacists Maggie and Morgan to delve into the key medications used in pediatric emergency medicine 🏥. They cover a wide range of topics, from proper medication dosing and pain control 💉 to antiemetics for nausea 😷, asthma management 🫁, and safe sedation practices 😴. The discussion also includes practical tips for advanced practice providers working in both community hospitals and pediatric-focused facilities 👩‍⚕️👨‍⚕️. Listeners will gain insights into common pitfalls in pediatric prescribing 🚫, the importance of proper dosing ⚖️, and strategies to effectively use medications like Tylenol, ibuprofen, Zofran, morphine, fentanyl, Decadron, and others 💊. The episode aims to enhance the confidence and skills of healthcare providers in caring for young patients 👶👧🧒. The show concludes with a look ahead to the next episode, which will focus on the febrile neonate workup 🍼.

00:00 Introduction to Pediatric Emergency Medicine

00:42 Meet the Hosts and Guests

02:08 Common Pitfalls in Pediatric Prescribing

03:51 Basics of Antipyretics: Tylenol and Ibuprofen

10:03 Anti-Emetic Medications: Zofran and Alternatives

21:19 Pain Control Strategies in Pediatric ER

26:42 Pediatric Dosing and Medication Caps

28:06 Fentanyl: Usage and Administration

29:26 Intranasal Medication Techniques

31:30 Pain Management in Pediatric Emergencies

34:58 Enemas for Constipation Relief

40:00 Asthma Management in Pediatric Patients

48:18 Sedation Techniques in Pediatric Care

52:00 Conclusion and Final Thoughts

🎉 In this special 1-year anniversary episode of PEM CHATT, host Toni Dobson reflects on the podcast’s growth and welcomes guest Dayna Jaynstein, PA, to discuss the critical topic of maternal mortality. Together, they explore why the U.S. has the highest maternal mortality rate among developed countries, highlight the unique risks for Black and Native women, and introduce ACOG’s new initiative to help non-OB providers recognize and manage OB emergencies. The episode covers key warning signs, the importance of asking about current pregnancy status and delivery within the last year, and practical algorithms for managing cardiovascular and hypertensive emergencies in pregnant and postpartum women. Listeners are encouraged to use these resources, advocate for patients, and share knowledge to help prevent maternal deaths.

Link to ACOG website with algorithms: ACOG.org/obemergencies

⏰ Timeline:

0:00 – Welcome & 1-year anniversary celebration

2:00 – Podcast journey & gratitude to listeners

5:00 – Guest introduction: Dana Jane Dean, PA

7:00 – Maternal mortality stats & disparities

10:00 – ACOG’s new initiative explained

15:00 – Key questions for providers & identifying at-risk patients

20:00 – Cardiovascular emergencies in pregnancy

25:00 – Hypertensive emergencies & management tips

30:00 – Eclampsia, preeclampsia, and medication guidance

35:00 – Family-centered care & advocating for moms

40:00 – Resources, final thoughts, and next episode preview

In this episode of 🎤PEM CHATT, host Toni Dobson is joined by pediatric clinical pharmacists 💊Maggie Raker and 💊Morgan Padron for an in-depth discussion on antibiotic use in the pediatric emergency department. The conversation highlights the unique and invaluable role clinical pharmacists play in patient care, from assisting with medication selection and dosing to providing real-time support during traumas and codes. Maggie and Morgan share their backgrounds and offer practical insights into the collaborative approach between pharmacists, providers, and nurses.

The episode dives into evidence-based strategies for treating common pediatric infections 🦠, including ear infections, UTIs, pneumonia, animal bites, cellulitis, and more. Listeners will learn about first-line therapies, dosing nuances, and the importance of selecting targeted antibiotics. The team also shares helpful resources and tips for staying current with best practices. This episode is a must-listen for anyone seeking to deepen their understanding of pediatric antibiotics and the importance of clinical pharmacy collaboration in emergency medicine.

Resources Mentioned:

• Maggie and Morgan’s antibiotic guide with ID man: https://drive.google.com/file/d/1ZLNEeUAXlG8hvX_rycAASB3PZ5x0GOuh/view?usp=sharing
• Ninja Nerd’s YouTube lecture on antibiotics: https://www.youtube.com/watch?v=GGtwJ-SGXTA&t=7s
• Sanford Guide, EMRA app, and UpToDate for antibiotic selection

Part two of this series with Maggie and Morgan will cover other common medications in the pediatric ER (coming December 2025).

Next month: 🤰🏻Special episode on OB emergencies for the one-year anniversary of PEM CHATT.

Thank you for listening to PEM CHATT! 🫶🏽

Disclaimer: The content in this podcast is for educational purposes only and does not constitute medical advice. Always consult your local guidelines and collaborate with your physician leader as appropriate.

In this episode of PEM CHATT, host Toni Dobson is joined by Dr. Sarah Sterner, a pediatric emergency medicine physician and medical director at Children's at Erlanger, to discuss chest pain in children. The discussion delves into the differences between pediatric and adult chest pain presentations, common causes, high-risk diagnoses, and appropriate workup strategies. The episode includes discussions on real-life case scenarios, covering conditions such as hypertrophic cardiomyopathy, myocarditis, pericarditis, pneumothorax, and more. Dr Sterner also discusses why it is important to admit children with persistent tachycardia. The importance of a systematic approach, thorough history-taking, and recognizing potential red flags in pediatric patients is highlighted.

• WATCH on YouTube: https://www.youtube.com/@PEMChatt

00:00 Introduction to PEM CHATT

00:19 Understanding Pediatric Chest Pain

01:28 Introducing Dr. Sarah Sterner

03:22 Common Causes of Chest Pain in Children

04:05 Don't Miss Diagnoses

05:03 Approach to Pediatric Chest Pain Workup

06:31 Case Study: 14-Year-Old Male with Chest Pain

11:54 Case Study: 5-Year-Old Female with Chest Pain

22:23 Understanding Myocarditis

23:05 Pericarditis in Children

24:59 Pneumonia Management

25:56 Case Study: 9-Year-Old with Chest Pain

29:25 Case Study: 16-Year-Old with Pneumothorax

32:19 Case Study: 15-Year-Old with Pneumomediastinum

35:03 Rare but Serious: ACS and PE in Kids

39:58 Conclusion and Final Thoughts