PEM Chatt

About PEM Chatt

A peer-to-peer educational podcast about pediatric emergency medicine. Hosted by Toni Dobson, DNP, APRN, FNP-C, ENP-C, RNC-OB, a Nurse Practitioner at Children's at Erlanger Emergency Department and Erlanger’s Obstetric Emergency Department.

Publisher

Toni Dobson

Category

education · health & fitness · science

Language

en

Explicit

No

First episode

6 Nov 2024

Latest episode

2 Oct 2026

Latest episodes

22 episodes in the feed.

1. 

   2 Oct 2026

   22 | Rapid Recognition and Management of SCAPE (flash pulmonary edema) in the ED with Brandi Ganatra

   🎙️ PEM CHATT Podcast: SCAPE (Sympathetic Crashing Acute Pulmonary Edema) 📍 Special Adult EM Edition, Live from the AAENP Conference in Nashville, Tennessee 🎧 Host: Toni Dobson🩺 Guest: Brandy Ganatra, an acute care/ICU nurse practitioner who now works in emergency medicine in Nebraska⏱️ Runtime: About 6 minutes 📝 Episode Summary In this special adult emergency medicine edition of PEM CHATT, Toni talks with Brandy Ganatra at the AAENP conference about SCAPE, or sympathetic crashing acute pulmonary edema. This is the patient many of us learned to call "flash pulmonary edema." Brandy covers the pathophysiology behind the newer name, how to recognize these patients quickly, why high-dose nitroglycerin is the mainstay of treatment, and why early, aggressive management in the ED can turn a crashing patient around in minutes. 🔑 Key Takeaways 🫁 What Is SCAPE? SCAPE is sympathetic crashing acute pulmonary edema, the presentation many clinicians know as "flash pulmonary edema." The term is fairly new. Cardiology often calls it acute decompensated heart failure, but critical care and ED literature increasingly use "SCAPE." The name points to the pathophysiology, and the pathophysiology points to the treatment. Think bigger than "the lungs are full of fluid." ⚡ The Pathophysiology A sympathetic surge causes marked peripheral vasoconstriction and a sharp rise in systemic vascular resistance (SVR), which is the afterload the left ventricle has to pump against. The core need is afterload reduction. 🚨 Recognition: What Does It Look Like? Extremely tachypneic and tachycardic Profoundly hypertensive Hypoxic and tripoding, with severe respiratory distress Pink, frothy sputum from acute pulmonary congestion Onset is sudden. "It happens in an instant." Common history: heart failure or hypertension, sometimes with missed medications 💊 Management: High-Dose Nitroglycerin + Non-Invasive Ventilation 💊 Nitroglycerin is the mainstay of therapy. Lower doses mostly cause venous dilation, which is why nitro is used for angina and ischemia. SCAPE calls for high doses. Brandy starts IV nitro at 100 mcg/min and may titrate up to 400 mcg/min. One sublingual nitro tablet is roughly equal to 80 mcg/min, which puts the IV dosing in perspective. "It's not as scary as we think." Nitro has a short half-life (about 2–5 minutes). Titrate down instead of turning the drip on and off. 😮💨 Support breathing at the same time. Use non-invasive ventilation (CPAP/BiPAP) for the high work of breathing, with the goal of avoiding intubation. 🔀 Do things in parallel, not one at a time. We like our ABCs, but here several interventions need to start together. 📋 A practical sequence: Give sublingual nitroglycerin. While you do that, set up non-invasive ventilation. While you do that, prepare to start IV nitroglycerin, then titrate. With timely afterload reduction, restored cardiac output, and breathing support, these patients can turn around in 15–20 minutes. 🔄 💎 Final Pearls 👀 Recognize it early, monitor closely, and treat aggressively. Timing and the right management are critical. 🤝 Teamwork is essential. 🚫 Don't get stuck on diagnostics. Don't wait for a chest X-ray to confirm it. Put the POCUS probe on 🔍 and look for volume overload. 💪 Act quickly and with confidence. Current literature supports high-dose nitroglycerin as safe and effective in the ED. ⏰ Episode Timestamps [00:00] Intro: special adult EM edition from the AAENP conference [00:18] Meet guest Brandy Ganatra [00:39] What is SCAPE, and why the new name? [01:28] How bedside management has changed: getting comfortable with high-dose nitro [02:41] Recognition: what these patients look like [03:17] Nitroglycerin dosing: low vs. high dose, starting at 100 mcg/min [04:00] Nitro safety: short half-life, and sublingual compared with IV [04:50] Turning patients around in 15–20 minutes [05:12] Take-home points: teamwork, POCUS, a

2. 

   15 Apr 2026

   21 | Submersion Injuries with Dr Sarah Lazarus

   21 | Submersion Injuries with Dr. Sarah Lazarus In this episode of PEM CHATT, host Toni Dobson is joined by pediatric emergency physician Dr. Sarah Lazarus to break down the critical topic of pediatric drowning and submersion injuries. Together, they explore real-world clinical scenarios, debunk common myths, and provide practical guidance for both clinicians and caregivers. Drowning remains one of the leading causes of death in children, particularly ages 1–4, and even non-fatal events can result in devastating long-term consequences. This episode emphasizes both clinical management and prevention strategies—highlighting how quickly these events occur and how often they happen despite close supervision. 🔑 Key Takeaways Drowning is fast and silent Often occurs in seconds with little to no splashing or noise Terminology matters “Dry drowning” and “secondary drowning” are outdated and misleading Pathophysiology is respiratory Water aspiration → surfactant washout → impaired gas exchange → hypoxia Observation is critical True aspiration events should be monitored for ~6 hours from the time of incident Imaging isn’t always helpful Chest X-rays can lead to unnecessary admissions without changing outcomes Management is symptom-driven Asymptomatic → observe Symptomatic → oxygen support, VBG, imaging, admission Cardiac arrest cases are severe Focus on oxygenation, ventilation, rewarming, and consider ECMO early Prevention requires layers No single strategy (including swim lessons) is sufficient ⚠️ Clinical Pearls Drowning is an evolving process, not a single moment event Patients should be observed for 6 hours after the event Symptoms appearing days later are NOT due to drowning Pediatric arrests are often respiratory in origin → prioritize ventilation Antibiotics and steroids are not routinely indicated Most toddler submersion injuries do NOT require C-spine immobilization 🧠 Myth Busting “Dry drowning” isn’t real.This term originated from outdated medical concepts but is no longer used. If a child had a true submersion injury, symptoms will present within 6 hours—not days later. 🛟 Prevention Insights Use “arms reach, eyes reach” supervision Perform a home swim test (can the child swim 2 pool lengths?) Understand that: Swim lessons ≠ drowning proof Life jackets ≠ guaranteed safety Drowning prevention requires multiple overlapping layers of safety Resources and references: Brenner’s article: https://pubmed.ncbi.nlm.nih.gov/19255386/ CHOA Algorithm: https://www.choa.org/-/media/Files/Childrens/medical-professionals/clinical-practice-guidelines/submersion-event-ed.pdf NEJM Article: https://www.nejm.org/doi/full/10.1056/NEJMra1013317#figures_media Timeline 00:00 Welcome to PEM CHATT 00:19 Why Drowning Matters 01:12 Meet Dr. Sarah Lazarus 02:14 Bread Pudding is my favorite 03:34 Drowning Terminology 04:38 Who Is Most at Risk 06:08 Silent Drowning Explained 09:15 Systemic Effects Checklist 11:03 Fresh vs Salt vs Cold 11:46 Three Patient Categories 12:36 Case One Asymptomatic Kid 14:12 Avoiding Unneeded X-Rays 16:12 Case Two Symptomatic Infant 18:40 Imaging and Labs Strategy 18:58 When to Skip Antibiotics 20:02 Arrest Scenario Walkthrough 20:30 Resuscitation Priorities And ECMO 21:54 When Resuscitation Is Futile 22:40 C-Spine Immobilization Debate 23:24 Drowning CPR Starts with Breaths 25:29 Injury Prevention Work and Stats 27:14 Layers of Drowning Prevention 30:01 Dry Drowning Myth Busting 33:16 Key Pearls and Closing

3. 

   6 Mar 2026

   20 | Rewind: Preparing for the Return of Vaccine Preventable Illnesses with Dr. Meg Wang

   In this “Rewind” episode, Toni sits down with retired pediatrician Dr. Margaret “Meg” Wang, who trained and practiced through the pre-vaccine and early-vaccine eras of pediatrics, including the 1989–1990 measles epidemic in New York City. Together, they walk us through what pediatrics looked like before Hib, pneumococcal, varicella, and rotavirus vaccines and what we might face again as vaccination rates fall and herd immunity wanes. You’ll hear vivid, frontline stories of: Hib meningitis, occult bacteremia, and epiglottitis in infants and toddlers, when full sepsis workups (blood, urine, CSF, IV antibiotics, 72-hr admissions) were standard for many febrile children through 36 months of age. “Old-school” periorbital and buccal cellulitis from Hib—bright red with a violaceous hue, toxic kids, high fevers, and automatic LP + admission. Measles in an actual epidemic: the prodrome with the “three Cs” (cough, coryza, conjunctivitis), Koplik spots, and that classic confluent, head-to-toe rash, plus why measles is not a mild illness. Varicella beyond the “nuisance rash”: super-itchy multi-stage lesions, serious skin infections, and a child who developed Staph aureus bacteremia and tricuspid valve endocarditis requiring open-heart surgery—all from chickenpox in an unvaccinated child. Rotavirus winters: the green, watery, diaper-filling diarrhea, relentless fluid losses, metabolic acidosis, hypoglycemia in infants, and frequent admissions—versus the near-disappearance of severe rotavirus disease after the vaccine. Clinically, Toni and Dr. Wang dig into: How fever protocols for 0–36 month-olds have evolved from routine full sepsis workups to today’s more nuanced approach with viral testing and inflammatory markers like CRP and procalcitonin. Bedside pattern recognition for epiglottitis (toxic, drooling, tripod positioning, chin thrust, neck extension) and why you never upset these kids or put a tongue blade in their mouth—just get them upright and straight to controlled intubation with anesthesia. The role of parental gut instinct and why “this is not my kid” should always make you pause and reassess. 🔑 Key Takeaways: Vaccines didn’t just reduce visit volumes; they completely changed inpatient and ED workflows, procedure rates (LPs!), and long-term morbidity (e.g., deafness after meningitis). As coverage declines, we won’t just see “more fevers”—we’ll see sicker kids, more invasive procedures, more admissions, and more preventable complications. Your vaccine counseling today is part of preventing tomorrow’s “Rewind” from becoming reality again. 📌 Call to Action: Hit play, then share this episode with a colleague, resident, or trainee who has never seen these diseases and thinks of measles or chickenpox as “mild.” Their future patients are counting on it. 💉🧠

Who has been a guest on PEM Chatt

Names identified in recent episode analyses. Showing up to five guests.

• Dr Lindsay McHale
• Maggie Raker
• Morgan Padron
• Dayna Jaynstein
• Dr Sarah Sterner

Reach and audience

Public platform figures. Ratings count people who left a rating, not total listeners.

YouTube views

96

Score snapshot 15 Sept 2025

Apple Podcasts (US)

5.0 / 5

1 ratings

Podcast Authority Score: 36 / 100

A composite of feed quality, social presence, YouTube performance and engagement. Read the methodology.

Quality

48

Social presence

0

YouTube

63

Engagement

0

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Guest appearances

Books guests

Based on episode analysis; this does not confirm that the show is currently accepting guests.

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