You’ve finished years of training and finally have that job you’ve been working towards. You’re doing your first shift as a new PEM attending and a child arrives to your ED with a high fever and a rapidly progressing rash. Is he the needle in the haystack with meningococcemia? Or is he one of the hundreds of children in your community with an enteroviral infection? Should you start antibiotics and notify your nearest ICU colleagues? Or should he be discharged home with supportive care? Is there any evidence available to help with these vital decisions?
Just as your heart rate is returning to normal, a child is brought in via EMS after being struck by a car. You’re worried about his belly, and the surgeon is already pushing the ultrasound machine to the bedside. The bedside nurse asks you to explain why the surgical team is asking for a FAST exam on this patient. Do you know that the FAST exam for detecting intraabdominal injury is less than 66% sensitive in children?
Clinical decision-making in uncertain situations is one of the things that makes PEM both thrilling and disconcerting. Why isn’t the answer clearer? What isn’t there more time to make the decision? Are there really unlimited clinical scenarios you’ll be faced with?
Jeff Seiden and Robert Belfer, PEM attendings at The Children’s Hospital of Philadelphia, have created a seminar called PreGame CME that is geared toward PEM fellows and junior attendings. According to Dr. Seiden and Dr. Belfer, it will provide practical, evidence-based approaches to both common and life-threatening presentations of pediatric patients to the ED.
While PEMNetwork does not have any formal association with this conference, it does seem to address high-yield topics and clinical decision-making that can be the most anxiety inducing parts of the job so I thought it’d be worthwhile to pass along. And if high-yield learning isn’t your cup of tea, the seminar is called “PreGame CME” for a reason: it’s in Ann Arbor, Michigan this fall and is timed so that you can go to the Michigan vs. Wisconsin football game that same weekend. Let us know if you go, what you thought about it, and what 100,000 screaming people in a stadium is like.
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