Leading the EMS World in Pediatric Education
Thursday October 19th 2017

Pediatric Chest Pain: Not Your Father’s Chest Pain – Episode 11


Kids having chest pain? Really?! Should we be breaking out the aspirin, nitroglycerin, and 12-leads? Well that depends upon what the cause of that chest pain is.

As a great compliment to our syncope episode, pediatric chest pain is an infrequent complaint that may be the result of any number of things from trauma, to infection, to cardiac-related causes.  Join Russell Stine, Arnold Facklam, and Kyle David Bates as they talk to Dr. Lou Romig about this perplexing complaint that kids may actually present with.

**I  apologize about the audio quality. We had some issues with the microphones and technology but found it still to be a fascinating episode!

Pediatric Chest Pain outline

The Listener will be able to:

  1. Identify and discuss the various etiologies of pediatric chest pain.
  2. Obtain and interpret pertinent history of a pediatric patient having chest pain.
  3. Perform and interpret an assessment of a pediatric patient having chest pain.
  4. Discuss appropriate treatment of a pediatric patient having chest pain.

A pediatric chest pain slide presentation

Chest Pain in Children and Adolescents

From Dr. Lou:

Here’s a brand new article (Management of Pediatric Chest Pain Using a Standardized Assessment and Management Plan, Pediatrics, Vol 128, No 2, Aug 2011) that looked at 406 children from 7-21 yrs of age presenting during 2009 for  outpatient evaluation for pediatric chest pain at Children’s Hospital Boston. Of the 406 pts, only 5 had a cardiac etiology – 2 had pericarditis, 2 had SVT and 1 had nonsustained episodes of V-tach (? etiology). The pericarditis patients had abnormal EKGs and classic complaints and physical findings. All arrhythmia patients complained of palpitations as well as chest pain. 8 patients were found to have previously undiagnosed incidental cardiac diagnoses not related to the chest pain (1 WPW pt and 7 structural cardiac abnormalities). 99% of the patients referred for cardiology evaluation for chest pain were determined to have noncardiac sources for their pain. Keep in mind that this is 99% of the children referred to a specialist for their chest pain. There are undoubtedly many more who were not referred. This reinforces two of the main points in our chest pain session: 1) the overwhelming majority of kids with chest pain are not having an acute cardiac event and 2) the small number of patients that are having a cardiac event have positive histories, physical exams and/or EKG

There’s also a concise review article on causes of pediatric sudden cardiac death (Recognize the Warning Signs of Sudden Pediatric Cardiac Death, R. Slaven, BS, NREMTP) in the August 2011 issue of JEMS. The article’s title is just a touch misleading because it’s not assessment-based but the review of some of the causes of sudden cardiac death in children and young adults should peak your curiosity and give you a place to start if you’re interesting in further researching the topic.


Done Fell Out! Pediatric Syncope Episode 10


Kids pass out? Really? Yes they do! Join Kyle David Bates as he talks with Dr. Peter Antevy and Dr. Lou Romig as they discuss pediatric syncope and how it may be more common then we think!

ERCAST / Pediatric Syncope

Pediatric Syncope: Cases from the Emergency Department

Electrocardiogram Sine Wave in Hyperkalemia

Wolff-Parkinson-White Syndrome

Long Qt Syndrome

  1. The listener will be able to define pediatric syncope.
  2. The listener will be able to compare and contrast syncope and seizure.
  3. The listener will be able to identify potential causes of pediatric syncope.
  4. The listener will be able to identify patients suffering from a potential syncopal event.
  5. The listener will be able to obtain a relevant history of a pediatric patient with possible syncope.
  6. The listener will identify and perform a pertinent assessment of a patient with syncope.


Summertime Fun! Episode 9


Summer is here, but so are its related injuries and illnesses. Join Dr. Romig, Dr. Antevy, Chris Cebollero, Russell Stine, Tim Noonan, and Kyle David Bates as they discuss heat and water related emergencies. We also reference an interesting website as well in regards to heat-related injuries to children.

  1. The listener will be able to discuss common causes of heat-related injuries in the pediatric population.
  2. The listener will be able to identify and manage a pediatric patient suffering from a  heat-related injury.
  3. The listener will be able to discuss pediatric drownings.
  4. The listener will be able to assess and manage a pediatric patient who has drowned.
  5. The listener will be able to discuss proper airway and ventilatory management of a pediatric patient who has drowned.

ALTEs: Don’t Miss the “Near Misses”


We’ve all had those calls. You know the ones that I am talking about. Dispatch sends you to an infant that is unresponsive and not breathing but when you arrive the child is fine. The parents look at you for advice so what did you tell them? Did you dismiss what they told you as being overprotective parents or first-time parent syndrome? Did you tell them to take their child to the pediatrician in the morning? Well if you did you may have not served that child, or their parents, well. In fact that child may have experienced an apparent life-threatening event, or ALTE which may be signs of a more serious underlying condition.

Join us this week as Dr. Lou Romig, Dr. Peter Antevy, Wilma Vinton, Kyle David Bates, and Arnold Facklam discuss ALTEs and their correlation, if any, to SIDS.

Also, please help us in helping Bryan Stow, the AMR paramedic assaulted at an LA Dodgers game and left in a coma. You can find more information and donate at www.support4BRYANstow.com.

Episode References

Evaluation and Management of Apparent Life-Threatening Events in Children (Am Fam Physician. 2005 Jun 15;71(12):2301-2308.)

Apparent Life-Threatening Events in Infants Presenting to an Emergency Department. (A Emerg Med J 2002;19:11-16 doi:10.1136/emj.19.1.1)

SIDS & EMS: What should we do? (JEMS. 2009 Jan 20)

Wear Your Helmet, a Bear May Attack! Ep 7


While at the 17th Annual IREMSC Symposium in Fairbanks, Alaska we were able to sit down with Dr. BJ Coopes to discuss various pediatric topics with focus on the rural setting. Dr. Coopes also presents a case study of a girl who was attacked by a grizzly bear and survived thanks to her bike helmet. We discuss airway management, injury prevention, and many other topics.

Let’s Get A- HEAD of this! Episode 6


Do you stand-by at sporting events? If you do then this episode is for you.

This week we discuss sports-related traumatic brain injuries (TBI) of the pediatric patient. Are you aware that simple heading the ball in soccer, clicking of the helmets in football, or hitting the helmet against the boards in hockey may be enough to cause a traumatic brain injury? No? Well then you are most likely thinking of the MVC-related TBI. But in in fact concussions are a common injury, many go undetected.

Listen in this week as Russ Stine, Kyle David Bates, Dr. Lou, Romig and Dr. Peter Antevy discuss the recognition, assessment, and management of the pediatric patient.

References from tonight’s episode

CDC Traumatic Brain Injury website

American Academy of Pediatrics’ Clinical Report on Sport-Related Concussions in Children and Adolescents

American Academy of Neurology Position Statement on Sports Concussion

Annals of Medicine: Offensive Play

Facts About Fever: Information You “Mythed”


What is fever? How high does a it have to get before it is considered dangerous? What is the best way to manage a fever in the out-of-hospital environment?

Join Scott Keir, Scott DeBoer, Kyle David Bates, and Drs. Romig and Antevy as we discuss a topic that has warmed us all and listen to the discussion as things get a little “hot under the collar” this week.

Intranasal.net website

The Handtevy Method Infant and Child Dosing

From Dr. Peter Antevy, “As a little trick….I teach healthcare providers how to quickly determine the doses of Tylenol, Motrin and Benadryl using the Handtevy method.

Age (yr):   1    3     5     7    9
Wt ( kg):  10  15   20   25  30
From there the dose of Children’s Tylenol, Children’s Motrin and Benadryl are all just half the weight (kg).
So a 1 year old…..10 kg kid gets 5 mL of all three drugs
3 year old 15 kg kid gets 7.5 mL etc….
So once you know the age you can rapidly determine the weight and from there easily get to the the approximate dose for that child.”

Holiday-Related Calls Episode 4


Join Dr. Lou and Kyle as they sit basking in the glow of a warm fire, sipping some eggnog, and sing some Christmas carols. Well…maybe that IS stretching it a bit. Anyways, join us as we talk about holiday-related injuries and illnesses. Chomping on ornaments, chewing on batteries, and sucking on poinsettias are just a few of the topics we discuss on this special Christmas episode.

Merry Christmas and Happy New Year everyone!

  • the Pedi-U gang

Sponsored by:

Measuring and Drugging Your Kids: Pediatric Drug Dosing Episode 3


It’s 3am and you need to give your pediatric patient a medication.

How much do you give them? How do you determine their weight? Should you use a length-based tool, actual weight, ideal body weight, or any other number of methods? Should we make adjustments based upon if the medication is water or lipid soluble?

Then there is the ultimate question: should we really give them medication at all? What about pain management?

These are all questions that Ted Setla, Kyle David Bates, Dr. Lou Romig, and Dr. Peter Antevy discuss on this episode.

An example of  pediatric point-of-care references that breakdown medications based on our protocol. The formulas are also included. Each box contains the appropriate equipment for that particular weight range:

Epinephrine Dosing

Weight based calculation by age

Ambulance personnel perceptions of near misses and adverse events in Pediatric patients

It’s Wheezin’ Season! Episode 2


As the leaves begin to fall and the weather turns cold we know that we have left summer and moving into…WHEEZIN’ SEASON!

Yep, it is that time of year again when we start to see an increase in the number of pediatric respiratory calls they we respond to. Join Dr. Lou Romig, Scott DeBoer, Natalie Quebodeaux, and Kyle David Bates as they discuss many common respiratory complaints, assessment PEARLS, and treatment options of these small people.

Episode References

Best evidence: steroid use in bronchiolitis

Emedicine review of bronchiolitis

Examples of pertussis (whooping) cough

Racemic epinephrine compared to salbutamol in hospitalized young children with bronchiolitis; a randomized controlled clinical trial

Review of “bronchitis” in children

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