The Peds NP: Pearls of Pediatric Evidence-Based Practice

Vasoactive agents in cardiogenic shock (S4 Ep. 33)

Cardiogenic shock occurs in children for a variety of reasons, and there are a variety of vasoactive drugs available to treat the critical condition.  But first we need to understand the pathophysiology and pharmacology to best select the drug for the job, which is no easy task.

References

Bolick, B.N., Reuter-Rice, K., Madden, M.A., Severin, P.N. (2020). Pediatric Acute Care: A guide for Interprofessional Practice (2nd ed.). Jones & Barlett Learning. Burlington, MA.

CDC. (2020). Data and statistics on congenital heart defects. Retrieved online from https://www.cdc.gov/ncbddd/heartdefects/data.html

Hughes, H.K., & Kahl, L.K. (2021). Harriet Lane Handbook. Manual for Pediatric House Officers (22nd ed.). Philadelphia, PA: Mosby.

Manaker, S., Parsons, P.E., & Finlay, G. (2020). Use of vasopressors and inotropes. Retrieved online from https://www.uptodate.com/contents/use-of-vasopressors-and-inotropes?csi=40383b7b-fb7e-48d4-a09d-2d8706878bb1&source=contentShare

Pringle, C.L. (2017). PICU Essentials (1.4.0.305) [Mobile application software]. Retrieved from https://apps.apple.com/us/app/picu-essentials/id1207366521.

Bronchiolitis in the Hospitalized Patient (S4 Ep. 32)

The 2014 AAP guidelines on the treatment of bronchiolitis are a provider's medical decision-making compass, but how can we interpret the vague or absent recommendations involving advanced care of patients requiring hospitalization? This episode covers the recent evidence published since the 2014 guidelines and helps to provide some direction on key issues for patients in need of greater respiratory support.  

References:

Coletti, KD, Bagdure DN, Walker LK, Remy KE, Custer JW. High flow nasal cannula utilization in pediatric critical care: an observational study. Respir Care 2017;62(8):1023-1029.

Elliott, S.A., Gaudet, L.A., Fernandes, R.M., Vandermeer, B., Freedman, S.B., Johnson, D.W., &… Hartling, L. (2021) Comparative efficacy of bronchiolitis interventions in acute care: A network meta-analysis. Pediatrics, 147(5), e2020040816. doi: 10.1542/peds.2020-040816.

Kalburgi, S., & Halley, T. (2020). High-flow nasal cannula use outside of the ICU setting. Pediatrics, 146(5), e20194083. doi: 10.1542/peds.2019-4083.

Leyenaar, J.K., & Ralston, S.L. (2020). Widespread adoption of low-value therapy: The case of bronchiolitis and high-flow oxygen. Pediatrics, 146(5), e2020021188. doi: 10.1542/peds.2020-021188.

Mahant, S., Wahi, G., Bayliss, A., Giglia, L., Kanani, R., Pound, C.M., & … Canadian Paediatric Inpatient Research Network (PIRN). (2021). Intermittent vs continuous pulse oximetry in hospitalized infants with stabilized bronchiolitis: A randomized clinical trial. JAMA Pediatrics, 175(5), p. 466-474. doi: 10.1001/jamapediatrics.2020.6141.

Mallory, M.D., Shay, D.K., Garrett, J., & Bordley, W.C. (2003) Bronchiolitis management preferences and the influence of pulse oximetry and respiratory rate on the decision to admit. Pediatrics, 111(1), e45-51. doi: 10.1542/peds.111.1.e45.

Nutrition in Critical Care (S4 Ep. 31)

Nutrition is arguably the most important component of care in children with critical illness, yet its importance often falls down the list of priorities. Many questions remain on how best to manage nutrition in pediatric critical care, but this episode addresses many best practices from the SCCM and ASPEN's Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient.

References

Mehta NM, Bechard LJ, Zurakowski D et al. Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: a multicenter, prospective, cohort study. Am J Clin Nutr. 2015;102:199-206.

Mehta NM, Skillman HE, Irving SY, Coss-Bu JA, Vermilyea S, Farrington EA, McKeever L, Hall AM, Goday PS, Braunschweig C. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. Pediatr Crit Care Med. 2017 Jul;18(7):675-715. doi: 10.1097/PCC.0000000000001134. PMID: 28691958.

How to give a scholarly presentation (S4 Ep. 30)

Whether you're presenting in class, for colleagues, or on a national stage, it's important to have the tools and skills to disseminate your work in a scholarly way.  This week's show focuses on helping you with presentation format, PowerPoint visuals, and presentation skills to help you stand out and confidently demonstrate your expertise.

References:

Cuddy, A. (2012). Your body language may shape who you are. Retrieved online from https://www.ted.com/talks/amy_cuddy_your_body_language_may_shape_who_you_are?language=en#t-603306

Morgan, N. (2011). Why we fear public speaking and how to overcome it. Retrieved online from https://www.forbes.com/sites/nickmorgan/2011/03/30/why-we-fear-public-speaking-and-how-to-overcome-it/?sh=5a85243f460b

Common Limb Deformities in Children (S3 Ep. 29)

"What's wrong with your legs?' 'Nothin' at all, thank you. My legs are just fine and dandy.'" This episode takes a line from Forrest Gump and RUNS with it.  It's important for providers to know normal MSK development from an intrauterine fetus to the running child so that you can give parents reassurance for normal, expected defects while referring true deformities.  

References:

Espandar, R., Mortazavi, S.M.J., & Baghdadi, T. (2010). Angular deformities of the lower limb in children. Asian Journal of Sports Medicine, 1(1), p. 46-53. doi: 10.5812/asjsm.34871

Gupta, P., Gupta, V., Patil, B., & Verma, V. (2020). Angular deformities of lower limb in children: Correction for whom, when and how? Journal of Clinical Orthopedics and Trauma, 11(2020), p. 196-201. https://doi.org/10.1016/j.jcot.2020.01.008

Scherl, S.A. (2004). Common lower extremity problems in children. Pediatrics in Review, 25(2), p. 52-62. doi: 10.1542/pir.25-2-52

Amoxicillin Allergy (S3 Ep. 28)

Ten percent of Americans report an allergy to amoxicillin, yet most of these don't represent a true allergy. Today we discuss the types of drug allergies, how to determine if the allergy can be removed, and second line drugs for true PCN allergy with the goal of being outstanding stewards of antimicrobial stewardship.

References

American Academy of Pediatrics. (2013). The diagnosis and management of acute otitis media. Pediatrics, 131(3), p. e964-e999. doi:10.1542/peds.2012-3488

Chaudry, S.B., Veve, M.P., & Wagner, J.L. (2019). Cephalosporins: A focus on side chains and beta-lactam cross reactivity. Pharmacy, 7(3), p. 103. doi: 10.3390/pharmacy7030103

Mill, C., Primeau, M.N., Medoff, E., Lejtenyi, C., O’Keffe, A., Netchiporouk, E., … & Ben-Shoshan, M. (2016). Assessing the diagnostic properties of a graded oral provocation challenge for the diagnosis of immediate and nonimmediate reactions to amoxicillin in children. JAMA Pediatrics, 170(6), e160033. doi:10.1001/jamapediatrics.2016.0033

Shenoy, E.S., Macy, E., Rowe, T., & Blumenthal, K.G. (2019). Evaluation and management of penicillin allergy: A review. JAMA, 321(2), p. 188-199. doi:10.1001/jama.2018.19283

Shulman, S.T., Bisno, A.L., Clegg, H.W., Gerber, M.A., Kaplan, E.L., Lee, G., … & Van Beneden, C. (2012) Clinical practice guideline for the diagnosis and management of Group A Streptococcal pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 55(10), p. e86-102. DOI: 10.1093/cid/cis629

Vyles, D., Chiu, A., Routes, J., Castells, M., Phillips, E.J., Kibicho, J., & Brousseau, D.C. (2018). Antibiotic use after removal of penicillin allergy label. Pediatrics, 141(5), e20173466. doi: 10.1542/peds.2017-3466.

How to ace the test and eat a burrito (S3 Ep. 27)

I've got incredible burrito-eating skills like you've never seen.  These epic Tex-Mex talents translate to test-taking strategies that are a sure-fire way to effectively implement critical thinking.    

References:

Fernandez-Plaza, A., Saiz-Mendiguren, R., Garcia-Lallana, A., Viteri-Ramirez, G., Etxano, J., & Bondia Garcia, J.M. (2012). Ileo-ileal intussusceptions in a child complainting of abdomnial pain. Eurorad, Case 10092. doi: 10.1594/EURORAD/CASE.10092

Maaks, D.L.G., Starr, N.B., Brady, M.A., Gaylord, N.M., Driessnack, M., & Duderstadt, K.G. (2019). Pediatric Primary Care (7th ed). St Louis: Saunders Elsevier.

PNCB. (2019). PNCB announces unprecedented action for CPNP-AC exam integrity. Retrieved online from https://www.pncb.org/sites/default/files/resources/CPNP-AC_Exam_Press_Release_FINAL_3-4-2019.pdf

Wiersma, F., Allema, J.H., & Holscher, H.C. (2006). Ileoileal intussusception in children: ultrasonographic differentiation from ileocolic intussusception. Paediatric Radiology, 36(11), 1177-1181. doi: 10.1007/s00247-006-0311-2

Kids say the darndest things! (S3 Ep. 26)

When patients (or parents!) use unique phrasing of a phenomenon, we must interpret their description of the experience in laymen's terms using clarifying questions while being attentive to inaccurate use of medical terms.  Let a kid tell you their story and you'll learn everything you need to know.  Hear what I mean with a couple of real GI examples from my week.

References

Tate, J.E., & Bresee, J.S. (2012). Principles and Practice of Pediatric Infectious Diseases (Fourth ed.). Elsevier: China.

What are you wearing?: Navigating guidelines in bronchiolitis (S3 Ep. 25)

Having a sense of fashion and listening to what the style gurus tell us "what not to wear" is similar to provider practice and the clinical practice guidelines published by our national authorities.  Yet, somehow jorts came back into fashion and albuterol trials remain common practice for bronchiolitis.  What will you wear and do?

References

Condella, A., Mansbach, J.M., Hasegawa, K., Dayan, P.S., Sullivan, A.F., Espinola, J.A., & Camargo, C.A. (2018). Multicenter study of albuterol use among infants hospitalized with bronchiolitis. Western Journal of Emergency Medicine, 19(3), 475-483. doi: 10.5811/westjem.2018.3.35837

Ralston, S.L., Lieberthal, A.S., Meissner, H.C., Alverson, B.K., Baley, J.E., Gadomski, A.M… & Hernandez-Cancio, S. (2014). Clinical practice guideline: The diagnosis, management, and prevention of bronchiolitis. Pediatrics, 134(5), e1474-e1502. doi: 10.1542/peds.2014-2742

Heat and Sun Issues in Summer (S3 Ep. 24)

As the hottest part of summer approaches and kids spend more time playing outside, pediatric providers need to be ready to recognize heat-related illness and offer savvy perspectives on how to protect kids from the sun's harmful rays.  

References:

American Academy of Pediatrics. (2011). Ultraviolet radiation: A hazard to children and adolescents. Pediatrics, 127(3), 588-597. doi:10.1542/peds.2010-3501

Center for Biological Diversity. (2021, March 9). Hawai’I senate bill bans harmful sunscreen chemicals. https://biologicaldiversity.org/w/news/press-releases/hawaii-senate-bill-bans-harmful-sunscreen-chemicals-2021-03-09/

Mangus, C.W., & Canares, T.L. (2019). Heat-related illness in children in an era of extreme temperatures. Pediatrics in Review, 40(3), 97-107. doi: 10.1542/pir.2017-0322

U.S. Food & Drug Administration. (2017). Sun protective factor (SPF). Retrieved online from https://www.fda.gov/about-fda/center-drug-evaluation-and-research-cder/sun-protection-factor-spf