Your work is hard; staying current shouldn’t be. Keep your practice ahead of the curve with entertaining, engaging and concise pediatric topics from world-class educators.This iTunes segment is just one monthly free segment of the full Peds RAP show. Get 3 hours of fresh podcast episodes per month and 42 AMA PRA Category 1 credit(s)™ per year when you sign up for the full podcast at hippoed.com.Don’t forget to download the Peds RAP app in the app store for even more streamlined listening.
In recent weeks, many of our medical organizations have released official statements declaring racism to be a public health crisis. In this introduction to Hippo Education’s new Race and Medicine audio series, Dr. Jay-Sheree Allen sits down with Primary Care RAP host Dr. Neda Frayha for a candid conversation exploring the definition and types of racism, the historical and present-day manifestations of racism in medicine, and potential strategies we all can incorporate into our daily practices to go beyond the hashtag and become true allies. To view the references for this segment: Click Here
Sol Behar, MD and Jason Woods, MD get together to discuss the evaluation and management of bilious emesis in a neonate. Bilious emesis in an infant should be treated as an emergency because this is often a symptom of obstruction due to intestinal atresia or midgut volvulus. Causes of intestinal obstruction that present during the neonatal period include: Malrotation with or without volvulus Intestinal atresia Hirschsprung disease Intussusception (rare in the neonatal period) Necrotizing enterocolitis To view all the rest of the incredible show notes and see all the references Click Here
Drs. Brian Lin and Mike Weinstock discuss alterations to our usual practice patterns of laceration repair in the setting of the COVID pandemic, which include increasing patient throughput through faster closure techniques, reducing total points of contact with the healthcare system by using techniques to obviate the need for a return visit, and habit changes during closure to minimize exposure risk during face-to-face contact. To view the references and show notes from this podcast Click here
Dr. Mizuho Morrison & Dr.Jenny Beck Esmay both having had covid themselves, briefly discuss the clinical course and what presence of IgM vs. IgG signifies. They discuss what we currently know about antibody testing (national availability, reliability, sensitivity) as well as convalescent plasma transfusion (CPT) and criteria for donation vs. recipient. To view the references and show notes from this podcast Click here
*Editor's note: As of June 4, 2020, The Lancet article by Mehra MR et al has been retracted. (https://www.thelancet.com/lancet/article/s0140673620313246) In this Hippo Education short, Dr.Salim Rezaie from REBEL EM and Lit Matters critically appraises two papers published on Friday May 22nd, 2020. He discusses what the evidence shows for both remdesivir & hydroxychloroquine/chloroquine as effective treatment or prophylaxis for COVID-19. To view the references and show notes from this podcast Click here
COVID-19 causes STEMI’s, arrhythmias and myocarditis?!? Emergency medicine and cardiology guru Amal Mattu, MD chats with Mizuho Morrison, DO on the cardiovascular effects of COVID-19. They discuss: the known pathophysiology of how viral infections affect the heart; Review the new consensus statement from the Society of Cardiovascular Angiography and interventions (SCAI), American College of Cardiology (ACC), and the American College of Emergency Physicians (ACEP) on how to manage STEMIs; and lastly discuss how cardiac arrest management differs in this COVID era. To view the references and show notes from this podcast Click here
Children seem to be less affected than adults by the direct effects of COVID-19 infection, but the pandemic has brought forth other health risks to the pediatric population. Sol Behar interviews Oakland, CA based primary care pediatricians Celine Sparrow and Katie D’Harlingue about the indirect impact of COVID-19 on children. Topics covered include home school and academic achievement, mental health issues, and nutrition/food insecurity. To view the references and show notes from this podcast Click here
General pediatrician Cori Cross, MD and Sol Behar, MD review the good, the bad, and the annoying (for parents) aspects of social media use in children. To view the show notes and references for this episode CLICK HERE
In this Hippo Education update, Primary Care RAP host Dr. Neda Frayha interviews regular guest and Infectious Diseases expert Dr. Devang Patel for a discussion of where the IDSA stands on all the potential treatments for COVID-19, a review of the remdesivir paper that is all the rage lately, and a look back on whether or not their very first conversations on the novel coronavirus have stood the test of time. To view the references and show notes from this podcast Click here
Sol Behar, MD interviews New York City pediatric emergency physician Dr. Ee Tay, highlighting the features of pediatric COVID disease, including an emerging illness that is being compared to Kawasaki Shock Syndrome called “pediatric inflammatory multisystem disease” (PIMS). To view the references and show notes from this podcast Click here
Dr. Matthieu DeClerck talks to Dr. Manie Beheshti on how the healthcare system should approach the “re-opening” of society as we plan the lifting of social restrictions. What safety implementations need to be in place in order to protect our most vulnerable patients. What changes can we anticipate in the healthcare system moving forward? To view the references and show notes from this podcast Click here
UCSF pediatric intensivist Mindy Ju, MD breaks down the basic principles of mechanical ventilation in children with Solomon Behar, MD For references and to read the show notes Click Here Subscribe today for 3.5 hours of incredible content each month.
Psychiatrist Dr. Melissa Shepard sits down with Primary Care RAP host Dr. Neda Frayha for some real talk on the mental health challenges facing health care workers in the COVID-19 pandemic, and some concrete, tangible tools to help us get through this period. Spoiler alert: it’s more than yoga. To view the references and show notes from this podcast Click here
Dr. Matthew DeLaney and Dr. Michael Weinstock sit down to discuss the threat of lawsuits in the midst of the COVID pandemic. The last thing anyone wants to think about is the risk of a lawsuit. Unfortunately, despite the extra challenges posed by our current pandemic, the threat of medicolegal consequences remains. In this segment, we evaluate the unique medicolegal risks that can occur during disaster situations and look at potential sources of medicolegal protection. To view the references and show notes from this podcast Click here
Drs. Mike Weinstock and Josh Russell, from Urgent Care RAP, just published a landmark COVID study: CXRs obtained from confirmed and symptomatic COVID-19 patients presenting to the UC were normal in 58.3% of cases, and normal or only mildly abnormal in 89% of patients. Matthew DeLaney, MD joins in on the conversation in this important podcast. To view the references and show notes from this podcast Click here
Patients with COVID-19 present in a variety of ways and clinicians need to have a low index of suspicion for diagnosis. Management involves emergency referrals for patients with low oxygen saturation. Every patient should be treated as if they could have COVID-19. Mike Weinstock, MD, and Matthieu DeClerck, MD are joined by Frank Illuzzi, MD in this very important segment. To view the references and show notes from this podcast Click Here
There are so many active threads, subthreads, and sub-sub-threads of conversation in the medical community surrounding the COVID-19 pandemic. In this Hippo Education Short, Tom Robertson, MD and Steve Biederman, MD of Primary Care RAP’s Paper Chase take 4 hot topics in COVID-19 and examine the literature behind them. They look into the epidemiology of the outbreak in the U.S. and lessons learned, the sensitivity and specificity of SARS-CoV-2 testing, the rates of co-infection with other respiratory viruses, and convalescent plasma as a potential therapy. To view the references and show notes from this podcast Click Here
Mizuho Morrison, DO sits down with emergency medicine pharmacist/toxicologist Bryan Hayes, PharmD to answer some pertinent questions and myth-bust clarifications about pharmaceutical options in COIVD-19 treatment. To view the references and show notes from this podcast Click Here
Andi Marmor, MD and Lisa Patel, MD discuss why functional constipation occurs, the evidence behind prevention and treatment, appropriate treatment regimens for the outpatient setting, and when patients should be referred for inpatient clean out for constipation. To hear Part Two of this conversation and to view the show notes and references click here
Sol Behar, MD interviews Children’s Hospital of Philadelphia NICU doc Joanna Parga-Belinkie, MD to discuss Covid-19 and some of the peripartum issues that come up during the novel coronavirus pandemic for both pregnant moms and their newborns. For the show notes and additional references please click here
Has your clinical practice shifted to telemedicine yet? In the era of COVID-19, clinicians everywhere are being thrown into telemedicine, often without any experience or background knowledge. To help us all get up to speed with this patient care technology, Hippo Education’s Dr. Neda Frayha sits down with Dr. Edward Kaftarian, the Vice Chair of Mental Health at the American Telemedicine Association and CEO of Orbit Health Telepsychiatry. Together they explore the benefits and potential pitfalls of telemedicine, the equipment required, billing and coding considerations, appropriate etiquette, and much more. For more information and to view all the detailed notes and get all the references for this segment please click here
We know that there's a constant flood of information. So, we produced this podcast mini-series to help rapidly onboard healthcare professionals who don’t see COVID-19 patients regularly. We’re going to keep this simple and short, something you can listen to on your drive into work. We'll point out key clinical pearls and pitfalls that we've learned on the frontlines to help keep you and your patients safe. You can do this. Featuring Aaron Bright, MD and Salim Rezaie, MD
Most healthcare professionals know what personal protective equipment (PPE) is, but the reality is that many of us don’t use this everyday and are wondering if we’re doing it correctly. Let’s highlight where people make mistakes and expose themselves to risk. Featuring Aaron Bright, MD and Salim Rezaie, MD
For healthcare professionals who may get called in to help with COVID-19 patients, you will most likely be asked to help triage and manage ambulatory suspected COVID-19 patients. Here’s what you need to know. Featuring Aaron Bright, MD and Salim Rezaie, MD
Most healthcare professionals are familiar with oxygen supplementation and nebulizers, maybe even CPAP/BiPAP. Most of us should have some Basic Life Support (BLS) training to use a bag-valve-mask (BVM) in case of emergency. But there are some of this changes with COVID-19. Featuring Aaron Bright, MD and Salim Rezaie, MD
For healthcare professionals who do not often receive immediate laboratory results and diagnostic imaging reports, we’ll highlight unique diagnostic patterns and pitfalls with COVID-19 patients. Featuring Aaron Bright, MD and Salim Rezaie, MD
As healthcare professionals, we all recognize the increased risks we face as we care for our patients during the COVID-19 pandemic, but we must also care for ourselves, especially when we come home to our families. It’s normal to be concerned and one of the first things we can do is to start having conversations and plan ahead. Featuring Aaron Bright, MD and Salim Rezaie, MD
Our panel of podcast hosts from a variety of practice settings discuss the logistical and psychological impact of the COVID-19 pandemic on healthcare workers and discuss strategies to mitigate the stress associated with the pandemic. Featuring: Solomon Behar, MD, Neda Frayha, MD, Mike Weinstock, MD, and Matthieu DeClerck, MD References: Click Here
In this Hippo Education Short, Infectious Diseases specialist Dr. Devang Patel and our own Dr. Neda Frayha discuss the latest, clinician-focused updates on the COVID-19 coronavirus outbreak. Subscribe to PEDS:RAP today to support this show and the important work being done to provide you with the most up-to-date medical knowledge from the world experts in the field. https://www.hippoed.com/ For References go to: https://www.hippoed.com/peds/rap/episode/bonusshortcovid/covid19update
Solomon Behar, MD interviews Portland, Oregon based doctors Holly Tse, MD (urgent care) and Paul Lewis, MD (infectious disease and public health) to chat about the real world experience of responding to the measles outbreak in their community. There is so much more to PedsRAP each month. For more incredible education and 42 hours of CME CLICK HERE!
Andi Marmor, MD and Lisa Patel, MD review the cutaneous and systemic manifestations of HSV1, when testing is indicated, potential co-infections, and discuss management strategies depending on presentation. For more incredible segments like this, subscribe to PC:RAP today. You'll never miss a moment of the program and earn 42 hours of CME per year. Transmission of HSV-1 occurs when someone with no prior infection comes in contact with herpetic lesions, mucosal secretions, or skin lesions that contain HSV-1. Transmission can occur when infected body secretions come into contact with a break in the skin. In the acute phase of the infection, the herpes virus replicates at the site of contact. From there, the virus enters the sensory nerve and travels to the ganglion. Typically it establishes latency in the trigeminal nerve ganglion (or sacral ganglion depending on the initial site of infection) and it can then reactivate in any of the branches of that nerve throughout life. HSV PCR and viral culture are the two tests used to confirm the diagnosis of HSV. A viral culture can distinguish between HSV-1 and HSV-2. HSV PCR is typically faster and more sensitive than a viral culture. Serologic testing has a limited role in acute infection but can be helpful in establishing prior infection in someone who is, for example, undergoing an organ transplant where antiviral prophylaxis might be needed. Primary HSV-1 oral infection usually presents as gingivostomatitis in children.High fevers and malaise are the typical prodromal symptoms which are then followed by the development of painful vesicular lesions. Lesions can affect the entire gingiva and also often involves the buccal mucosa, tongue, and the floor of the mouth. There may also be some sores on the outside of the mouth and around the lips. In coxsackievirus, the majority of the lesions are in the posterior oropharynx whereas with HSV gingivostomatitis, the majority are in the anterior mouth. The distribution of the lesions can help distinguish between the two viruses. Children with gingivostomatitis may require hospitalization for pain control and/or dehydration. For pain management, Andi advises using around the clock NSAIDs and does not recommend using Magic mouthwash. Magic mouthwash is typically a 1:1:1: ratio combination of viscous lidocaine, diphenhydramine, magnesium hydroxide (or aluminum hydroxide) mixed with a flavored syrup. Andi does not recommend because 1) viscous lidocaine is well absorbed through the oral mucosa and can quickly reach a toxic level in young kids and 2) there is not much evidence showing that improves pain control or that helps kids hydrate. Honey was shown in a recent randomized control trial to both improve pain control and less than the time to healing. Acyclovir, in addition to supportive care measures, is recommended in children with severe symptoms and who present within 72-96 hours of disease onset. A Cochrane review from 2008 showed that it decreased the time to healing and lessened the amount of pain medicine needed. The typical dosing is 15 mg/kg by mouth (maximum single dose 200 mg) five times per day. Herpetic whitlow (see image below, photo credit: Solomon Behar) is an infection of the soft tissue of the finger caused by HSV. It is usually localized to the nailfold. These lesions are initially clear-yellow vesicles that then coalesce into a larger blister. Herpetic whitlow is often confused with a bacterial infection like paronychia or a pulp abscess. Unlike a paronychia, the area filled with pus is not tense in the setting of herpetic whitlow. Treatment in most cases is doing nothing. The time that this takes to resolve is two to three weeks. Consider treatment with acyclovir if it is on multiple digits, if the child is systemically ill, or if there is concern for a more widespread infection.
In this Hippo Education Short, Infectious Diseases specialist Dr. Devang Patel sits down with our own Dr. Neda Frayha to discuss what we know so far about the new 2019-n-CoV coronavirus outbreak and what front-line clinicians can do if we suspect a patient of ours might have this viral illness. References: Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med, 24 Jan 2020. DOI: 10.1056/NEJMoa2001017. Munster VJ, Koopmans M, van Doremalen M, et al. A novel coronavirus emerging in China - key questions for impact assessment. N Engl J Med, 24 Jan 2020. DOI: 10.1056/NEJMp2000929 Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 24 Jan 2020. https://doi.org/10.1016/ S0140-6736(20)30183-5 Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet, 24 Jan 2020. https://doi.org/10.1016/S0140-6736(20)30154-9 Phan LT, Nguyen TV, Luong QC, et al. Importation and human-to-human transmission of a novel coronavirus in Vietnam. N Engl J Med, 28 Jan 2020. DOI: 10.1056/NEJMc2001272 Wuhan Coronavirus - 2019-n-CoV. Infectious Diseases Society of America. https://www.idsociety.org/public-health/wuhan-coronavirus/. Accessed 29 Jan 2020 2019 Novel Coronavirus (2019-n-CoV), Wuhan, China. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/summary.html. Accessed 29 Jan 2020. Update and Interim Guidance on Outbreak of 2019 Novel Coronavirus (2019-n-CoV) in Wuhan, China. Centers for Disease Control and Prevention. https://emergency.cdc.gov/han/han00426.asp. Accessed 29 Jan 2020. Resource: Centers for Disease Control and Prevention 2019-n-CoV PUI Case Investigation Form: https://www.cdc.gov/coronavirus/2019-ncov/downloads/pui-form.pdfpdf icon
Andi Marmor, MD and Sol Behar, MD review clinical features, complications, and latest treatment options of strep pharyngitis. GAS as a cause of pharyngitis is most commonly observed in children 5–15 years of age. Diagnostic studies for GAS pharyngitis are not recommended for children under 3 because acute rheumatic fever is rare in children
Rita Agarwal, MD and Lisa Patel, MD discuss safe prescribing practices in the age of the opioid epidemic. Rita outlines when opioids are appropriate for pain management versus when to consider other medications or modalities. She discusses the PILLS pneumonic to counsel families on storage, safety, and disposal of these medications. And she discusses how to manage patients with difficult to treat pain syndromes. Click here and subscribe to hear Part 2 and get 3.5 hours of CME each month CLICK HERE!
Sol Behar, MD and CHOP NICU doc Joanna Parga-Belinkie, MD review the evidence behind some of the peripartum practices that happen in the delivery room and in the immediate aftermath. There is so much more to PedsRAP each month. For more incredible education and 42 hours of CME CLICK HERE!
High flow nasal cannula is being used with increasing frequency on pediatric ward floors for children with bronchiolitis. Lisa Patel, MD and Andi Marmor, MD discuss the evidence on its use to reduce escalation of care and decrease length of stay. They also discuss how to start, titrate and wean settings on HFNC. There is so much more to PedsRAP each month. To listen to Part 2 of this incredible segment and even more incredible education along with 42 hours of CME CLICK HERE!
Given the recent spike of VAPI (vaping associated pulmonary injury) cases, our HIPPO medical editorial team review the clinical presentation and latest management recommendations for this lung disease. Mizuho Morrison and Sol Behar discuss a recent case, and review the hot-off-the-press published CDC health alert. Take a listen! Pearls: There has been a recent explosion in vape associated pulmonary injury, with serious morbidity and mortality. VAPI has been more commonly associated with THC-containing products ,although a wide variety of nicotine containing products and devices have been reported. Symptoms: Constitutional symptoms (100%) Respiratory distress and cough (98%) GI symptoms: nausea, vomiting, diarrhea (80%) Fever (30%) Diagnosis: Vaping in past 90 days, bilateral pulmonary infiltrates on imaging, Ground-glass appearance noted on CT chest. Absence of detectable bacterial/viral infection. Treatment: Respiratory support Steroids may be beneficial Antibiotics alone do not appear to help as this is not an infectious process, rather an inflammatory one. However given initial mixed presentation, it is not unreasonable to initiate antibiotics until pneumonia is ruled out and diagnosis is confirmed. References: Layden JE1,Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin - Preliminary Report. N Engl J Med. 2019 Sep 6. https://www.cdc.gov/media/releases/2019/p0906-vaping-related-illness.html https://emcrit.org/ibcc/vaping-associated-pulmonary-injury/ https://health.ny.gov/press/releases/2019/2019-09-05_vaping.htm How would you like to listen to 6 months of full episodes for free? For the month of September, when you refer a friend to sign up for Peds RAP, you'll get 6 free months of Peds RAP for yourself--on top of the $25 Amazon gift card you get for every friend who signs up! Start sharing below! Refer a friend
Michael Cosimini, MD and Liza Green Golan Mackintosh, MD get together to talk about the updated AAP clinical report for post-partum depression screening that was released January of 2019, and discuss the importance of the pediatrician screening women for this perinatal mood and anxiety disorder in their clinics. They discuss when to screen, how to screen, and what resources are available for referral, in addition to discussing the effects of maternal depression on infants. Thanks for listening to Peds RAP on iTunes. We hope you've learned some fantastic pearls so far from the free chapter segments. How would you like to listen to 6 months of full episodes for free? For the month of September, when you refer a friend to sign up for Peds RAP, you'll get 6 free months of Peds RAP for yourself--on top of the $25 Amazon gift card you get for every friend who signs up! Start sharing below! Refer a friend
Jessica Schumer, MD and Andi Marmor, MD talk about the importance of social determinants for children’s health outcomes, particularly where the child lives as an important factor for their health. Jessica also talks us through school-based health centers as a model to address equity and the role pediatricians can play in advocating for children’s health. There is so much more to PedsRAP each month. For more incredible education and 42 hours of CME CLICK HERE!
Christine Mirzaian, MD MPH, Solomon Behar, MD, and Liza Green Golan Mackintosh, MD discuss the special medical needs for infants born prematurely, including how to track an infant’s neurodevelopment accounting for their corrected gestational age, the risk and need for follow up for retinopathy of prematurity, which premature infants qualify for palivizumab, and how long to keep a premature infant on fortified formula. Subscribe to hear Part 2 and get 3.5 hours of CME each month CLICK HERE!
Yvonne Gutierrez MD and Parul Bhatia, MD discuss the physical exam findings associated with single suture craniosynostosis (SSCS), posterior positional plagiocephaly and posterior plagiocephaly secondary to lambdoid CS. They also talk about the two most commonly used surgical techniques used to correct SSCS and what is known about the neuro-developmental outcomes associated with SSCS. There's so much more practice changing audio each month when you subscribe to the full show. Click here to sign up today!
Carol Wilkinson MD, PhD and Lisa Patel, MD discuss normal milestones in this age group such as social behaviors like joint attention and early language and intentional movement for gross motor skills in addition to discussing red flags that would necessitate early referral to a specialist. There is so much more to PEDRAP each month. For more incredible education and 42 hours of CME CLICK HERE!
We all advocate for our patients on a regular basis, but how many of us have blown the whistle on a massive public health crisis? In this segment, Neda Frayha interviews Dr. Mona Hanna-Attisha, the Flint, MI pediatrician who opened the world’s eyes to lead in the water that was poisoning Flint’s citizens. They talk about how to become a more effective patient advocate, and how to face situations that feel scary but ultimately benefit our patients. For more incredible education and 3.5 hours of CME each month CLICK HERE!
Sol Behar sits down with UCLA pediatrician and researcher Adam Schickedanz to discuss the impact of Adverse Childhood Experiences on the physical and mental health of children. An adverse childhood experience or event is a stressful or traumatic experience before age 18. ACEs fall into three categories: 1) abuse, 2) neglect and 3) household dysfunction. ACEs disrupt social connections early in life. Subscribe to hear the rest of this months program
Liza Green Golan Mackintosh MD, and Solomon Behar, MD discuss the nuances of managing neonatal hyperbilirubinemia with pediatric superstar/doctor/researcher Vinod Bhutani. Yes, that Dr. Bhutani.
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Drs. Parul Bhatia and Sol Behar discuss the red flags for chronic abdominal pain and categories of functional abdominal pain for those kids with chronic abdominal pain and no red flags for serious organic pathology.
Dr. Paul Offit is a world-renowned expert on the safety and efficacy of vaccines. He has authored over 160 articles, co-invented the rotavirus vaccine, and been featured on shows like “60 Minutes,” “The Daily Show,” and “The Colbert Report,” among many others. In this segment, Sol Behar and Neda Frayha pick Dr. Offit’s brain about why our patients may be skeptical about vaccines and how best to communicate with them for the safety and wellbeing of all our patients.
Lyme disease is transmitted by ticks in endemic areas. The tick needs to be attached for at least 36 hours to transmit the disease and the classic initial presentation is erythema migrans rash plus viral symptoms (fever, malaise). Featuring: Jason Woods, MD and Solomon Behar, MD