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Lung Ultrasound: Has it gone viral?

This was an 8-month old baby girl who was brought into your ED in the middle of February with some increased work of breathing. She was an otherwise full-term, healthy baby but had fever and URI symptoms for the past few days. On exam, he is extremely cranky and difficult to console, making a lung exam challenging. He is febrile, tachypneic and retracting and noted to have an oxygen saturation of 88%.  While he is being put on supplemental oxygen and are awaiting portable chest X-ray, you perform a lung ultrasound to further assess the etiology of his symptoms and obtain the following images:   Clip Read more [...]

Are We Being ‘MOC’ked?

After certification by the American Board of Pediatrics, we commit ourselves for life long learning. The Board has clearly defined this process in recent years, implementing what is called the Maintenance of Certification or MOC. A great deal of controversy surrounds this multi-step process, which repeats in 5-year cycles. When I ask my friends in other professions if they work under similar regulations or continuous testing to maintain their jobs, the universal answer is no. In healthcare, we are always drained of time, money, and effort to maintain what we have. Meanwhile, politicians Read more [...]
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Doctor Cents: Two for the Price of One!!!

Tax time is just around the corner. That is April 15th for those of you wondering—the day that the federal government requires you to fill out all your paperwork and lay out your financial life to them so they can make sure you paid your “fair share.” Today’s post will deal with one of the best vehicles to help lower the amount you are required to pay to the tax man and also help you turbo charge your retirement savings goals---truly two for the price of one!   What is this magical entity that will reduce your taxable income and also provide for your retirement years you ask? Read more [...]
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Carrots, sticks, and games for changing physician behaviors

New Year’s resolutions—sadly fading into the rear view mirror for many of us— are an exercise in breaking old habits and creating new ones. For example, I wanted to keep my kitchen workspace clean as I cooked—more like the professionals or at least the 9 year-old contestants on Master Chef Junior. But when I left home this morning, I had still had two used cutting boards, a salad spinner, and a bunch of mixing spoons and utensils strewn on my counter. Sigh. How many of you spent the first 2.5 months of 2015 working on a improving something in your life? And how many of you have been wildly Read more [...]

Top PAS Picks for the Pediatric Emergency Medicine Physician

PAS is just around the corner in San Diego, CA April 25th-24th.  With a program that reads more like a book, the options for learning and networking are endless.  The PEMNetwork is happy to recommend the following core meetings and fun workshops of particular interest to PEM. 1. The PEMNetwork meeting Saturday April 25th 1pm-2pm, Hilton Bayfront Hotel The PEMNetwork holds an in-person meeting only two times per year - at PAS and at the NCE.  These meetings are open to everyone with agendas based mainly on website improvement, newsletter topics, and mission reassessment.  Attending Read more [...]
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Promotions and Academic Scholarship, Part III – Measuring Scholarship (publications)

Question: How many publications do I need to be promoted to assistant professor - associate professor - professor? Answer: Enough. This is a frustrating question to answer.  Part of knowing how scholarly you are means you have to keep track of publications.  Even though we know that multiple forms of scholarship exists, in the discipline of academic medicine, publications are still the gold standard.  We also know that not all publications are counted, ranked, or considered equally.  But most places do not offer specific guidelines, and your ability to be promoted (or at least know that Read more [...]
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Disruptive technology in PEM: A case for emergency ultrasound

Last week, a patient with systemic lupus arrived in the Emergency Department complaining of shortness of breath. She was mildly tachypneic and uncomfortable with any movement. A chest radiograph was ordered. While she waited, I did a quick bedside ultrasound (shown above), revealing a large right-sided pleural effusion, extending all the way to her axilla. Her bedside echo did not reveal a pericardial effusion. I went ahead and began planning her inpatient pleurocentesis. The CXR was done soon after and was read as possible effusion versus infiltrate of the right sided. How has my practice Read more [...]
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Answer: “This Is Spinal Tap.”

This post is in response to the post “This is Spinal Tap.” To summarize, this was a 3-week old boy who required a full septic work-up after he presented to the ED with a fever.   You performed a point-of-care ultrasound to help identify potential spaces to perform the tap and obtained 3 images. A                                                      B                                                      C   Thank you to everyone who took the quiz! 100% of you guessed correctly Read more [...]