OPENPediatrics

In this video, the viewer will learn to define brief resolved unexplained events, recognize the clinical presentation, diagnose and risk stratify a patient and understand the principles of management. LEARNING OBJECTIVES Upon viewing this presentation, participants will be able to: • Define brief resolved unexplained events (BRUEs) • Recognize the clinical presentation of BRUE • Diagnose and risk stratify a patient • Understand the principles of management AUTHORS Jonathan Fried Harvard Medical School Beth Harper, MD Pediatric Hospitalist Boston Children's Hospital Instructor in Medicine Harvard Medical School DATES Initial publication: January 11, 2019 CITATION Fried J, Harper B, Rubin L, Erickson A, McFee A, Wolbrink T. Approach to Brief Resolved Unexplained Events (BRUE). 1/2019. Online Video. OPENPediatrics. https://learn.openpediatrics.org/learn/course/internal/view/elearning/3538/approach-to-brief-resolved-unexplained-events-brue.

In this Complex Care Journal Club podcast episode, Dr. Eyal Cohen discusses the design and key findings of a randomized controlled trial evaluating the effectiveness of a structured complex care program in Ontario, Canada. He describes implications for clinical practice, opportunities for family partnership in research, and the next steps from this work. SPEAKERS Eyal Cohen, MD, MSc, FRCPC Program Head, Child Health Evaluative Sciences Staff Physician, Division of Pediatric Medicine The Hospital for Sick Children (SickKids), Toronto HOST Kathleen Huth, MD, MMSc Pediatrician, Complex Care Service, Division of General Pediatrics Boston Children's Hospital Assistant Professor of Pediatrics Harvard Medical School DATES Initial publication: April 26, 2023 CITATION Cohen E, Huth K. Measuring What Matters in a Multicenter RCT: Partnering With Patients/Families and Policymakers. 04/2023. OPENPediatrics. Online Podcast. Links: https://youtu.be/tTimlHM9Oj8, https://soundcloud.com/openpediatrics/measuring-what-matters-in-a-multicenter-rct-partnering-with-patientsfamilies-and-policymakers. ARTICLE REFERENCED Cohen E, Quartarone S, Orkin J, et al. Effectiveness of Structured Care Coordination for Children With Medical Complexity: The Complex Care for Kids Ontario (CCKO) Randomized Clinical Trial [published online ahead of print, 2023 Mar 20]. JAMA Pediatr. 2023;e230115. doi:10.1001/jamapediatrics.2023.0115 https://pubmed.ncbi.nlm.nih.gov/36939728/ TRANSCRIPT https://bit.ly/41Xvaf0 Clinicians across healthcare professions, advocates, researchers, and patients/families are all encouraged to engage and provide feedback! You can recommend an article for discussion using this form: forms.gle/Bdxb86Sw5qq1uFhW6 Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children’s Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user.For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

Dr. Michael Dean, a leading pediatric researcher at the University of Utah, dives into the intriguing world of ChatGPT and its potential within pediatric critical care. He explains how ChatGPT works, its applications in medicine, and shares personal insights on its promising features. Dean highlights both the advantages, like aiding clinical documentation, and challenges, such as accuracy and overreliance. He also stresses the importance of using accurate data to mitigate misinformation risks, paving the way for responsible AI integration in healthcare.

Dr. Helena Leahy, an expert in pediatric anesthesiology, dives into the critical issue of laryngospasm, discussing its risk factors and underlying mechanisms. She highlights essential signs and symptoms that healthcare providers should watch for, along with effective diagnostic methods. The focus then shifts to management strategies that can mitigate complications, particularly in children. With her insightful guidance, listeners will learn the crucial steps for prompt treatment in these high-stakes scenarios.

In this Nursing World Shared Practice Forum podcast, Dr. Hanrahan shares her research related to distraction for pediatric painful procedures. She reviews why this research is important, how it has benefited the pediatric patient population, and lists tools parents and caregivers can use to help them comfort children during painful tests and procedures. Following this discussion, participants will be able to: - Explain the Distraction and Action Tool and how it is used to predict a child’s risk of distress during medical procedures - Discuss how the research on distraction has impacted clinical practice - Explain how the Iowa Implementation and Sustainability Framework - Tool is used to successfully implement evidence-based practice in the clinical setting - List ways to engage parents in distraction techniques for their child Publication date: March 6, 2023. Articles Referenced: Hanrahan K, Kleiber C, Miller BJ, Davis H, McCarthy AM. The Distraction in Action Tool©: Feasibility and Usability in Clinical Settings. J Pediatr Nurs. 2018;41:16-21. (6:06) Cullen L, Hanrahan K, Edmonds SW, Reisinger HS, Wagner M. Iowa Implementation for Sustainability Framework. Implement Sci. 2022;17(1):1. (11:00) Citation: Hanrahan K, DeGrazia M, Shields R. Distraction for Pediatric Painful Procedures: Implementing an Evidence-Based Approach. 03/2023. Online Video. OPENPediatrics. https://soundcloud.com/openpediatrics/distraction-for-pediatric-painful-procedures-by-dr-kirsten-hanrahan-for-openpediatrics. Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children’s Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

In this World Shared Practice Forum podcast, Dr. Khemani discusses the new Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines, describing important changes from the previous PALICC guidelines and highlighting topics such as non-invasive ventilation, patient self-inflicted lung injury, and strategies for monitoring the breathing of a patient who is receiving invasive mechanical ventilation. Upon listening to this presentation, learners should be able to: - Identify the differences between the old PALICC guidelines and new PALICC-2 guidelines - Define patient self-inflicted lung injury - Explain new recommendations for monitoring patients receiving invasive mechanical ventilation Publication date: February 28, 2023. Articles referenced: Emeriaud G, López-Fernández YM, Iyer NP, et al. Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2). Pediatr Crit Care Med. 2023;24(2):143-168. doi:10.1097/PCC.0000000000003147 Khemani RG, Smith LS, Zimmerman JJ, Erickson S; Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: definition, incidence, and epidemiology: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;16(5 Suppl 1):S23-S40. doi:10.1097/PCC.0000000000000432 ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526-2533. doi:10.1001/jama.2012.5669 Citation: Khemani RG, Daniel D, Burns JP. Second International Guidelines for the Diagnosis and Management of PARDS. 02/2023. Online Podcast. OPENPediatrics. https://youtu.be/OeakKeoWXUk. Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children’s Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

In this World Shared Practice Forum podcast, Dr. Paul Offit discusses the viruses causing the so-called “tripledemic.” Dr. Offit reviews the virulence, transmission, and vaccine potential related to Respiratory syncytial virus (RSV). He shares current knowledge about the epidemiology and pediatric vaccination rates related to the Influenza A outbreak. Lastly, Dr. Offit gives an update on COVID-19 in the pediatric population, including details on current variants, the effectiveness and impact of the bivalent vaccines, and what to expect in the future. Upon listening to this presentation, learners should be able to: - Describe the surge of RSV infections observed in 2022, with likely causes - Explain the process of strain selection for the yearly Influenza vaccine - Summarize available data relating to the efficacy of the bivalent COVID vaccine Published: January 23, 2023. Citation: Offit P, Daniel D, Burns JP. Tripledemic: What we know so far and what to expect going forward on RSV, Influenza A, and SARS-CoV-2 in Children. 01/2023. Online Podcast. OPENPediatrics. https://soundcloud.com/openpediatrics/tripledemic-what-we-know-so-far-and-what-to-expect-going-forward-by-dr-paul-offit Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children’s Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

This podcast discusses the pre-operative, operative, and post-operative considerations for patients undergoing laryngeal cleft repair including: anatomy and pathophysiology, clinical presentation, diagnosis, pre-operative evaluation, anesthetic management, operative approach, and post-operative care. Upon viewing this presentation, participants will be able to: - Describe the anatomy and pathophysiology of a laryngeal cleft - List the common symptoms that a patient may exhibit with various types of laryngeal cleft. - Explain the approach used to diagnose a laryngeal cleft. - Describe the common preoperative evaluation for laryngeal cleft surgery. - Explain the anesthetic management plan for repair of type 1 and type II laryngeal clefts. - Describe the operative approach for repair of type 1 and type II laryngeal clefts. - Anticipate the post operative considerations following repair of type 1 and type II laryngeal clefts. Initial Publication: January 19, 2023 Citation: Laird-Gion J, O’Halloran A, Soohey R, Rahbar R, Watters K, Wolbrink TA. Laryngeal Cleft. 01/2023. Online Video. OPENPediatrics. Soundcloud link: https://soundcloud.com/openpediatrics/laryngeal-cleft. Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children’s Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

This video is a part of our Pain Series. In this episode, Dr. Corrie Chumpitazi gives an overview of pediatric pain management in the emergency department context, with a focus on education and advocacy toolkits for pediatric pain management that can be used nationwide. She discusses how to optimize both recognition and management of pediatric pain, with practical tips for determining medication selection and mitigating bias. She also talks about the use of opioids in treating pediatric pain, with consideration of healthcare disparities and changes in prescribing practices over time. The Pain Series is funded through the generosity of the MAYDAY Fund, which has, over the years, supported investigators and projects that have dramatically improved the pain management of children throughout the world. Upon viewing this presentation, participants will be able to: • Describe available approaches to assessing pediatric pain in the emergency department • Identify available tools for the recognition and management of pediatric pain • Discuss the role of opioids in treating pediatric pain, with consideration of changes in opioid prescribing practices over time • Identify racial and ethnic disparities in the treatment of pediatric pain DATES Initial Publication: March 8, 2023. ARTICLES REFERENCED • Ali S, Morrison E, Shwetz S, Yaskina M, Rajagopal M, Estey A, Drendel AL. An assessment of the psychometric properties of the Stoplight Pain Scale in a Canadian paediatric emergency department. Paediatr Child Health. 2021 May 26;26(7):421-427. (6:37) • Chang CD, Saidinejad M, Atanelov Z, Dietrich AM, Lam SH, Rose E, Ruttan T, Shahid S, Stoner MJ, Sulton C, Chumpitazi CE; ACEP Pediatric Emergency Medicine Committee. Emergency department strategies to combat the opioid crisis in children and adolescents. J Am Coll Emerg Physicians Open. 2021 Jul 21;2(4):e12512. • Chumpitazi CE, Chang C, Atanelov Z, et al. Managing acute pain in children presenting to the emergency department without opioids. J Am Coll Emerg Physicians Open. 2022;3(2):e12664. (18:14) • Goyal MK, Drendel AL, Chamberlain JM, et al. Racial/Ethnic Differences in ED Opioid Prescriptions for Long Bone Fractures: Trends Over Time. Pediatrics. 2021;148(5):e2021052481. (19:45) • Groenewald CB, Rabbitts JA, Gebert JT, Palermo TM. Trends in opioid prescriptions among children and adolescents in the United States: a nationally representative study from 1996 to 2012. Pain. 2016;157(5):1021-1027. (10:30) • Johnson TJ, Winger DG, Hickey RW, et al. Comparison of Physician Implicit Racial Bias Toward Adults Versus Children. Acad Pediatr. 2017;17(2):120-126. (21:57) • Kircher J, Drendel AL, Newton AS, et al. Acute pediatric musculoskeletal pain management in North America: a practice variation survey. Clin Pediatr (Phila). 2014;53(14):1326-1335 (16:48) • Tobias JD, Green TP, Coté CJ; SECTION ON ANESTHESIOLOGY AND PAIN MEDICINE; COMMITTEE ON DRUGS. Codeine: Time to Say "No". Pediatrics. 2016;138(4):e20162396. (11:03) ADDITIONAL REFERENCES • Emergency Medical Services for Children Innovation & Improvement Center (EIIC) toolkits (https://emscimprovement.center/education-and-resources/toolkits/) • EIIC/TREKK: Bottom Line Recommendations Pain Treatment (https://emscimprovement.center/education-and-resources/peak/peak-pediatric-pain/bottom-line-recommendation-pediatric-pain-treatment/) • Pediatric Education and Advocacy Kit (PEAK) toolkits: (https://emscimprovement.center/education-and-resources/peak/peak-pediatric-pain/) • Stoplight Pain Scale (https://stoplightpainscale.com/) CITATION Chumpitazi CE, Perez C, Daniel D, Wolbrink TA. Pediatric pain management in the emergency department. 3/2023. Online Video. OPENPediatrics. https://youtu.be/5ca1pFTXe5Q. Please visit: www.openpediatrics.org

This video is a part of our Pain Series. In this episode, Dr. Jean Solodiuk reviews approaches to the recognition and assessment of pain in children with intellectual disability. Dr. Solodiuk describes ways to define and measure pain in an individualized fashion, discusses collaborative approaches to pain management involving caregivers, and illustrates these principles using case examples. The Pain Series is funded through the generosity of the MAYDAY Fund, which has, over the years, supported investigators and projects that have dramatically improved the pain management of children throughout the world. LEARNING OBJECTIVES Upon viewing this presentation, participants will be able to: • Recognize the sources of complexity in defining the pain experience in children with intellectual disability • Apply an individualized approach to describing pain behaviors and severity for medically complex patients • Develop strategies to include caregivers in the assessment and management of pain CHAPTERS 00:00 Introduction 01:05 Behavior never lies 04:14 Definitions and overview 12:05 Pain assessment scales 14:49 Pain in children with medical complexity 19:21 Case Study #1 24:43 Understanding the pain behaviors of nonverbal children with intellectual disability 31:13 Case Study #2 ARTICLES REFERENCED • 2:00 McCrea RT, Tanke DH, Buckley LG, et al. Vertebrate Ichnopathology: Pathologies Inferred from Dinosaur Tracks and Trackways from the Mesozoic. Ichnos 2015;22:3-4,235-260. • 8:31 Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(3699):971-979. • 34:40 Morse BL, Solodiuk JC, Greco CD, Mauskar S, Hauer J. Initial Validation of GRASP: A Differential Diagnoses Algorithm for Children With Medical Complexity and an Unknown Source of Pain. Hosp Pediatr. 2020;10(8):633-640. DATES Initial publication date: December 22, 2022 CITATION Solodiuk J, Perez C, Daniel D, Wolbrink TA. Understanding the pain behaviors of nonverbal children with intellectual disability. 12/2022. Online Video. OPENPediatrics. https://youtu.be/-3dxNVOZv-Y. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu