Fighting Disinformation and Keeping your Kid out of the ER With Dr Nkeiruka

Transcript

Chris: 0:36

Welcome to pulse check, Wisconsin.

Speaker: 1:03

Good morning, good evening, good afternoon. This is Dr. Ford Pulse Check Wisconsin. Wanted to welcome you to another episode. We have a very special episode with Dr Nkeiruka., She's a pediatric emergency medicine physician and really looking forward to hearing some of her perspective, not only being a Peds EM doc, but being an international provider. So with that being said, feel free to sit back and here we go.

Chris: 1:36

Alright, well thank you so much for being here. I gave an intro of, to our audiences about you all the amazing things that you're doing. But if you could, could you tell us a little bit about your background

Dr Nkeiru: 1:47

so I am Anica. I am originally Nigerian. I did my medical school, grew up there, migrated to the US about, this is probably 11, 12 years ago for residency training. So that's why I did my medical school. And then after medical school, usually I actually finish, finished medical school wanting to do OB GYN for some reason. I don't know where, but at the end I realized it was more about the kids. So the way medical school works in Nigeria is after you're done with medical school like six, seven years, we then go through like a one year program where you're rotating through like four different specialties, medicine, pediatrics, ob, GYN, and surgery. So it was during the pediatrics rotation, I realized that I really fell in love with like Peds emergency. I'm like, this is like crazy enough. It's chaotic, but it's also very gratifying in terms of like, you see kids get better, you see them come like really bad, and then you're able to help them. So that's how I fell in love with Pete's emergency. And then how I got here is like, it's a long story being like an immigrant. So, but that's a completely difference

Chris: 2:46

I tell my students all the time when they're, when they're rotating with me. There's no greater lesson as a physician than to practice in different settings, right? Yes. And like you said, even from the specialty standpoint, being able to see everything rotate through it at the earliest stage possible in your medical, medical education, but also, like you said with your immigrant story, having the ability to practice in different countries and what that means for patients, what that means for communities and as a provider in some cases, you know, practicing. With a different standard of expectation. Right. So like the MRI when I was practicing overseas in, in Ethiopia was not a thing that was available. Right. And then I come back to Wisconsin and it's like I've been waiting six hours for my MRIs. Just, it's like, come on man.

Dr Nkeiru: 3:34

Appreciate a lot of things that we have here. Like you, like with CT scan? No. You have to schedule and come back a couple of days to get it done. Mm-hmm. If there's any, so it makes you really appreciate like. Stuff that you have that you never really had access to.

Chris: 3:48

Absolutely. And, and like you said, one of the things that I came across for our, for our listeners here, I'm gonna send out all of our videos, all of the links to her website as well, just because some of the videos are just amazing for new parents that are, that are coming up for, even teenagers. All these videos are very educational and they get into a little bit of what. We see common presentations to the emergency department, to the pediatric emergency departments too. And, and you know, I wanna dive into a couple of those concepts because I think it'll be really valuable for our listeners. One of the things that we talked about, and it, it, it piggybacks off of what we were just discussing there too, just how presentations are different versus here in the United States versus overseas. Here we're seeing, especially in the media. I, I believe you're in Texas, right? Yeah,

Dr Nkeiru: 4:32

I'm in Texas. Okay.

Chris: 4:33

So, so we're, we're, we were seeing this, this influx of new cases, quote unquote new cases of measles, and we see it in the media. We just saw some cases in Minnesota, I believe they just had somebody at O'Hare Airport in Chicago as well that went through there. And so everyone's, ears are perked up about measles. But you've had the opportunity in your career by practicing in Nigeria. To actually have seen that progression and, and, and do some of your advocacy. The video that I saw was doing advocacy to get patients to, you know, get that vaccination, to avoid those complications. Could you share with us some of your experiences just in working with that demographic of that population?

Dr Nkeiru: 5:10

Yeah. So I think it's very it's a really sad situation, right, right now to be going back, like, we're going back to like the seventies and sixties. Mm-hmm. When like vaccine preventable diseases were a thing, like a lot of time between nineteens and two, early 2000 things were getting better because then vaccines were seeing that really worse and things are getting all completely eradicated. I did medical school between the 1990s and 1999. I finished in 2006, so like. 2003, four, five were like peak times of like measles in Nigeria. And even like some other vaccination preventable diseases like polio, things, small pox were all eradicated before then. So Mesos is one of those things that we had a mezo word, and I can still remember. I mean, when you go through medicine, there's some cases you will see. It's like on one part of your brain. You never really take it out. It's there. So I can still remember some patients. I still remember, like a five year-old that I took care of who had like all the symptoms, the eyes, the breathing, and I still remember the location he was on, the po. This is I'm talking about in 2002. I still remember that. So I'm not saying this to scare people, but it's just to say that we know that this illnesses existed. Medicine. There's some places, especially in developed countries, you read some things in the book and you just have to remember the symptoms to be able to pass the examination. I didn't read that in the book. I saw the psych. You saw. Mm-hmm. I take care of the kids. Of course you have to all, we had protective where as much as we had, we didn't have all those like N95. So you are even going in there. To care for the patient not knowing if you're going to get infected. I was fully vaccinated, but it's like you have the protective wear enough of the ones you could, but you still have to care for these kids. So they're on what do they call it? Breathing support as much as we had available. Then of course, not all of them made it. One of the most common symptoms we also had was diarrhea, and of course Nigeria is a developing country, which is like diarrhea. And then in a combination of malnutrition, a lot of kids had more severe symptoms. I'm now going to, I mean, we have developed countries and developing countries. We had more severe symptoms, so they're coming in like dehydrated. We are losing some of the kids because they're having a lot of diarrhea in combination of other symptoms. So these are the things that. You know, you could prevent. Mm-hmm. And our vaccination status then was not because people were refusing vaccines, it was because we didn't have enough vaccines then. And also the storage made some of them not reliable. Mm-hmm. So even if these kids were vaccinated, they were not fully vaccinated. So like we had the vaccines or we didn't have enough. But people wanted it. Yeah. Now we're talking about now where we have the vaccines. We know that it works and people are refusing it because it's, I think we're now in a society where people think that they can do Google research. Yeah. Or they hear from other like wellness people and they think, oh, vaccine causing this. I'm not trying to discredit people's experiences and hesitancy, but I think secure sources from the right. Please. Mm-hmm. And do if you want to read stuff that people actually sent to you, there are people that are professional that have been doing this research for a long time. Mm-hmm. It's about what sources you're looking for. But please, Google is not the right place to find information for vaccines and say no, because I see things in the ER I've been seeing for a long time that are actually taking us back to where I really don't want us to get to. And,

Chris: 8:35

and, and, and, you know, Bravo. Right? And, and it's the thing, you know, don't see Google, don't seek. Instagram or TikTok, especially those avenues. In recent years it's been this wellness, I, I won't necessarily say attack, but it's, it's more so this wellness movement against the, the, the common, you know, western medicine medical societies where evidence-based medicine is, is, is our approach. And it's always been that approach, you know, in modern years where we're looking to say, okay, this is what the trials say. This is what the patient, data says, and this is what we're seeing in our population. And to be frank, we've had this almost nearly eradicated, right? Like you said, in like the, you know, early 2002 you know, 20 teens. We had this eradicated, and I believe the very first time you brought up a good point in that, you know, we read the books, we, we saw these case studies, we had it on tested in terms of, you know, the symptoms and you know, the spots and everything else. It was, and my first. Interaction with somebody with measles was in Minnesota when I was in pediatric emergency medicine fellowship. And that was the first time I had ever seen it. And that was the first time that the attending I was working with in 20, you know, who was a 20 year veteran, had seen it. Right. And so, you know, it, it's, it's one of those situations now that we're seeing it come back now. And I feel to your point also that a lot of people who are in that, you know, that wellness community in that, that anti-vax community, they seem like it, it seems to be this heir that it's not that big of a deal. What are, what are your thoughts on that? You've seen it.

Dr Nkeiru: 10:03

I think in terms of, there's a lot of confusion now, right? Mm-hmm. Before, I don't think we had a huge social media platform and things available compared to what we have now, and I think a lot of people, maybe there's been so many experiences they've had with healthcare, with vaccines that actually makes them sit on the fence. Yeah. So it's now about who is going to tip them over one side or the other. Unfortunately, the wellness and the anti-vaccine tend to be a little bit louder than the health professionals, and then somehow some health professional also like tired of fighting misinformation. Yeah. And tired of being. Bullied or threatened. I mean, I know after that means I know what my dms look like.

Chris: 10:46

Yeah. I'm telling you

Dr Nkeiru: 10:47

dms, so I know there's some people who are not able to continue to be able to spread the right information after this whole situation. I wish were able to. So I think that's the situation. So I'm not saying that there are no families that have not had that there are no families. That I've had or that had any like experiences that make me a little bit hesitant. It's about, I know you are hesitant, but I still need you to understand that going the opposite direction is going to make you worse. Like I work in the ed. I've had some families who like Vitamin Ks and another one that I'm having families that refuse. I've seen some kids come into the ER with bleeding. Bleeding because they didn't get. Okay. Mm-hmm. But how many people come back and share that experience on the internet? They don't. They share the ones that happened because they got it. Yeah. Which may not be really true. So that's what we need to be hearing. People that are having experiences for not receiving vaccines or receiving the right care or receiving the right things that are recommended should actually also come and speak up and say, Hey, this is what happened. I wanted to know that this is actually not right.

Chris: 11:49

Yeah. You know, I, I've seen some of your videos, especially on YouTube, where you're addressing, you know, and I like your approach to it as well. When you, you, you see it from both sides. And you, and you we're not saying that there hasn't been, you know, there's been zero accidents associated with vaccines. And we're not saying that, those patients experiences are not valid. But how, how do you approach it? How do you approach patients who are hesitant in the emergency department? And, and, and I'll go one further to say. I've seen patients that have come in, kids have been unvaccinated, and unfortunately we had to do the full septic workup, including the lumbar puncture and everything else, just because we're in a situation where we don't know what that is and the child is at increased risk and, and parents are floored to learn that we have to do all these invasive things. But how do you approach that in in your practice?

Dr Nkeiru: 12:38

This question is always, what is your hesitance? I want to understand from your point of view. What's what's your concern? What's the hesitancy? Where did you get the information from? Is this just like experience or this is what, like, I always want to hear that first because if they're telling me, oh, this happened to my child, or This is what my regular doctor said based on this, I usually give them some time. I say, this is what I know. I may not be able to convince you today. Mm-hmm. But this is what I know. This is the information. You're probably not going home today. So I want you to think about that. I'll let the inpatient team kind of help you, give you more information and help you make a decision. But is a family coming to tell me, like, it depends on the tone too, telling me, oh, this is what I saw on the internet. I'm like, no, this is like straight up like. It's completely wrong. This is what it is. This is what the evidence is, and I'm doing all this for your child now because you declined the vaccine based on no reason, based on maybe an uncle or aunt that say, this is what it is. No, this is incorrect and this is the right thing and this is what it is. It's up. I mean, everyone still decides what they want done for their kids. Mm-hmm. But in terms of, I mean, unless you want to sign against medical advice, which is something we don't recommend in kids. Yeah, but I can't hold you down, but this is. Letting you know that this is completely incorrect.

Chris: 13:51

Yeah. And and it is getting harder, right? And, and I don't want to get overtly political or anything like that, but when you have, you know, the HHS director saying one thing that again stands in direct opposition to some of the literature that we have. For years at a time now, it makes it harder for the patients and looking at it from their perspective to say what is real and what is fake? You know, what, what should I be putting my stock in, especially when I'm trying to look out for my family. But I will say, personally, one of the things that gives me pause. Is sort of the approach that we're seeing now taken to certain ailments and certain environmental diseases that affect, you know, the, the, the populations that are historically most affected by these conditions. Right. You know, we have here in Milwaukee a, a lead issue where we have lead in the soil. We have lead that recently was discovered here in our schools. And the, the, the, the federal government is not. Allocating the funds that were once, you know, previously allocated to those efforts. And so I see that, and as someone who was trying to be as objective as possible in this situation, my concern is if we have something that is, endemic in those communities, in those same communities like measles, right? That response is gonna be the same. Like, they're not, they're not just gonna jump up and say, okay, you know, the, the, the, this community is being disproportionately affected. Let's give them resources. So, you know, I think a lot of folks need to, to consider that too. You know, that that next step, if your child gets infected, now what? And so that, that, that's the, the other way to look at it.

Dr Nkeiru: 15:29

Yeah, definitely. I, I mean, sometimes you can provide people resources and just kinda wait for nature to do its thing. I can't, like, can't do anything. I've had families who maybe decline something before they're leaving, like, oh, probably just give us a vitamin K because I don't want this to progress. Like, absolutely. Which is great because now they learn from like experience. Mm-hmm. Which most of the time you don't want them to, but. Right. I mean, I don't have anything else to say versus this is what the research said, this is what is true, but that's all I have to offer at this point.

Chris: 15:59

Another thing I wanted to get in was some preventative steps. So a lot of the work that you do on your social media platforms is more so prevention to try to keep folks out of the emergency department, how to keep kids safe. What are some of the most common injuries and or presentations that you see to the pediatric emergency department in your practice?

Dr Nkeiru: 16:18

Yeah, so that's a pretty interesting question in terms it depends on the day. Mm-hmm. Mm-hmm. Like the air is one of those places. You always say you never know what you're going to expect till you get it. Like you may just go in and oh, it's sunny, and then you're seeing a bunch of injuries happening inside the house. So, depends on the season. So let's say now we're in the spring, a lot of kids, or spring versus summer, depending on where you are, a lot of people are going out. Side, it's like lawnmowing season. Mm-hmm. It is a garage. A lot of people doing work a lot around their garage and around the house. And then also kids are starting to go to the playground. So now I'm starting to see some lawnmower injuries, which may be to the eye or even like kids run over or maybe things with the garage, kids getting, amputation, which is like your finger cut off because they accidentally go through like a sharp machine in the garages. And then things like head injuries from a fall monkey bar, it's a huge one. Trampoline injuries and then sports injuries as well. So those are some of the things that we tend to see bees on the season. And then times where kids are more inside. Cold fall and winter. It's more like injuries from like playing inside the house, which you can't probably keep kids. Like you can't put them in a bubble. Mm-hmm. So like falls from jumping off like doors slamming on the fingers from like siblings running around in the house and stuff like burns as well. Those are some things we see like in the winter season.

Chris: 17:38

Yeah. And you know, this will probably be one of the more controversial things that I'll say on here, and it's gonna get people up in arms. I used to work for a plastic surgeon before I went to medical school, and he was a hand specialist. And he would see lawnmower injuries in kids so frequently that he would often come out and say, no child should be touching a lawnmower period. He was like, if you are under the age of 12, you shouldn't even be outside with a, with, with a lawnmower. And it's just because it, it's so unpredictable and we see it so frequently. You know, some of those, those wounds are, are, are devastating and in opposition to some of the things that you may see on tv. A lot of times those limbs can't be reattached. I know people come in with the ice bags and everything else and, and, but that's the reality that we deal with. So please, please, please stay away from the lawnmowers.

Dr Nkeiru: 18:29

Yeah, I usually tell people like once the lawn mower is out. Every child should be inside.

Chris: 18:34

Inside. Yep. Because

Dr Nkeiru: 18:34

people are like, oh my kid, I want to multitask. They can run around. Like you always have a lot of like loose things flying around and kids cannot be one place. They can sit inside and then you can move along. 'cause anything can happen in a split second, like you mentioned as well.

Chris: 18:49

Absolutely. One of the things that, one of the videos that, that I really liked that you did was on head injuries. So we see head injuries in kids. All the time. Matter of fact, my kid just fell like at nine o'clock this morning, so it, it, it is inevitable. But one of the things that, that you talked about was, was how you approach the old adage of you gotta keep these kids up. You know, as long as you can keep 'em up overnight, don't let 'em sleep. And I feel like as a provider myself, this is something that I run into and I make sure that I have to stay at the end of every visit just because the evidence has switched away from that. Could you talk a little bit about that and, and to that point?

Dr Nkeiru: 19:26

Yeah, so I mean that real, like it's, we still like having conversations around it, but head injury, like you mentioned, it's one when you mention kids. It causes head injury. Mm-hmm. Either from when you are young and curious, or maybe in sports and like active and teenagers like always trying to do stunt. Mm-hmm. So head injury always happen. So I want families to, I mean, as much as you feel bad when your child bumps their head, just always something very common. I always like to say, especially for younger ones, think about it this way. Like if no one told you that your child fell. Would you be worried about them? Let's say you walk out, now you see your child actively running around acting like themselves, and no one told you they fell. Is there anything you're worried about? If there's nothing that has changed, then the kid probably has moved on and they're recovering on their own. They're eating, playing like nothing happened. But if now you come out wondering why is my child stumbling? Why are they not talking like now? Why is something different and someone tells you, oh, they actually fell. Then I would want you to observe to make sure that something is not completely off. 'cause if they fell down, now all of a sudden they're very sedated in terms of like sleeping so much that you can't wake them up. They're vomiting a lot, or they're stumbling and being unsteady. They need an evaluation. When it comes to the part about head injuries, what we always concerned about and want an intervention is the brain bleed. Mm-hmm. Even fractures in kids, which is a broken bone, a skull fracture. Typically heals on its own, and even neurosurgeon, like, oh, there's nothing I need to do about fracture, because their bones are pretty, what do they call? They're pretty resilient. Yeah. And it heals very well. So when families hear about head injury, they think about fractures and think about concussion and forget. What we're worried about is the head bleed bleeding into the brain. The reason way I worry is that when there start to be a bleed in a container, it's squashing the rest of the things on the side, which is the brain. And anyone with the brain bleed is. What we call significant brain bleed is going to develop symptoms.

Chris: 21:26

Mm-hmm.

Dr Nkeiru: 21:27

And those are the symptoms we call red flags. So in the past we used to say if a child bumps their head, keep them awake. So you can see those symptoms. But then over time we realized that when a child bumps ahead, you keep them awake. Like if I bump my ahead and I'm all dizzy and and tired and you keep me awake, one, my brain is not recovering. Mm-hmm. And my head is not resting from what happened. So I will also be exhausted. So by the end of the four to six hours. People can't really tell are you exhausted from not resting or are you exhausted from the red flags getting worse?

Chris: 21:59

Do you need a CT that

Dr Nkeiru: 21:59

becomes excuse? Yeah, exactly. You can imagine. So a lot of people were ending up like in the ER and so many places get an evaluation because now you can't figure out why they're exhausted. Mm-hmm. So the reason we recommend letting them sleep is now they can sleep and rest even if it's a concussion, which have another real coming up. Even if it's a concussion, it helps with brain recover. And that recovery is what helps them get better. Red flags from head, head injury and bleeding manifests regardless of if a child is sleeping, meaning that they will be too sleepy, you can't even wake them up 'cause you want to go observe them. Say, call them and make sure they can recognize you like intermittently. But a child who has a significant head bleed and is having like red flags will be vomiting through the sleep, will not be able to wake up. Will look completely altered when you attempt to wake them or have like multiple, we can, which I can send to you to put in the caption so you can let them rest and sleep and just check on them and check the red flags. But please don't keep them awake because then you can't really tell what is going on after. So that's why we recommendations change and that's what we're recommending. Red. It's very difficult to convince families it is. It's very for that, but that's what we have to check on.

Chris: 23:15

Yeah. And, and, and to parents, again, you know, you, you're off the hook. Go ahead and let the kids sleep. I, I know it, it's really, and, and a lot of what we do, especially in pediatric emergency medicine too, right? Like a lot of it is this, this is the way that families have approached these issues for years at a time, years at a time. And you know, our. Our evidence in, in medicine, especially in pediatric changes so frequently, just based on, you know, that scientific approach that we do, the evidence that, that we're able to review. And then as we get more patient cases, we're able to review it again and just to make sure that those guidelines are up to date. But I will assure. Anyone listening. The pediatric guidelines for head injuries are one of the more rigorous studies that we have in medicine period. Like, you know, it, it is an outlier in that respect. And so if your child is not experiencing some of those red flag signs, as you said, that it is something that you can continue to watch your child, let 'em eat, let 'em go to sleep if they have a concussion, not letting 'em sleep is gonna make it even worse. Right. So, exactly. So just go ahead and let, let 'em be.

Dr Nkeiru: 24:20

Yeah, because I think some people always for, they'll always assume that if you let a child sleep, your concussion gets worse. No, no. There is a concussion regardless It has already happened. Yeah. And then like people always think, oh, I want a CT head or MRI to be able to make sure or tell me if it's a concussion. No, I can tell you it's a concussion based on their symptoms. Mm-hmm. A CT would tell me if there's a bleed. Or if there's a broken bone of like a skull fracture, but a CT is not helping us with a concussion. Mm-hmm. 'cause they probably already have it.

Chris: 24:47

Yeah, and that's a good point too. A lot of people come in and they, and they want that CT scan 'cause they wanna make sure that the child does not have that head bleed that we're talking about. But as you spoke to, you know, a lot of those times where there is a life-threatening bleed, like we will see it on the, on that clinical examination and, and like you mentioned as well. Concussion cannot be picked up at all on CT scan. The only way that you can potentially extrapolate some data based on that is on FM RI, which is our functional MRIs. And that's usually used in, in, in, in tests, in studies, right? Like that's not really used. It's not ready for prime to as of yet. So, you know, on the other end of that coin too, on the other side of that coin, it is. It is more so harmful for kids to continue to get those CT scans, you know, your lifetime of radiation exposure. We try to reduce it as much as possible in pediatric patients just because you're going to continue to carry that, that burden of that radiation exposure, which can precipitate cancers and things like that. So often we'll tell my patients, and I'm sure you do too, you know, we, we are mitigating this, you know, how much of a risk is associated with the head bleed versus. How much of a risk am I gonna expose this child to radiation and then increase their, their, their risk of cancer in the future? So it's a general balance that, that, that we work in.

Dr Nkeiru: 26:01

Yeah, definitely. Yeah. So true.

Chris: 26:04

So, one of the things too that you mentioned as well, it was more so the, the, the presentations to patients we see commonly. Fevers in the emergency department. Kids especially little kids, have a very interesting well, more so I would say distressing presentation to the hospital. Sometimes when they have a fever sometimes they may actually have seizures. And I just saw a patient it must have been last week at a rural location that I was working at, and the kid came in season and, you know, you, the whole hospital stopped just because this is a primarily adult hospital and you know.

Dr Nkeiru: 26:39

Adults. Once we got adults, I'm like, no, you need to go. I'm not

Chris: 26:42

ready. You need to go, bro. And, and it is right. And so, you know, if, if you don't see it often, you know, people, I mean, there were people repelling from the ceilings. It, it was insane. I, there were backpacks and everything. Everybody Just back up, everybody. We just need some Tylenol. Just, just so we, we call those febrile seizures. Could you talk a little bit about what that is and you know, just how distressing that can be for parents too?

Dr Nkeiru: 27:05

So yeah, feal seizures are one of those things that regardless of how many times each child has had it, it's always going to be scared for families.

Chris: 27:12

Mm-hmm.

Dr Nkeiru: 27:12

Growing up, one of my siblings actually had feal seizures Oh, wow. When I was seven, and I still remember like all those things. You remember like my, her shaking, having the seizures, my mom yelling, so it's very distressing. So fe seizures, essentially seizures that happen when kids have a fever, but it's within the ages of six months to five years. If your child is outside of this age range, we actually consider a more extensive evaluation and not call a feal seizure. So if your child is younger than six months old and has a seizure with a fever, we're more concerned about like another brain infection versus just a feal seizure. And if your child is older than five, I mean sometimes you say older than six years old. We don't consider it completely a febrile seizure, so we do a little more extensive evaluation. So the reason that we understand kids have febrile seizures because at that age, the way their brain responds to a fever is a little bit different, triggers more electrical activity, and that's way their body responds. And depending on how long it lasts, what type of seizure it can be characterized into like. Simple and complex fibro seizure. So depends how long you're season for. And most of the time the simple ones, although people always confuse this is one your whole body shaking. Mm-hmm. Versus where one side is shaking. I mean, I have like an extensive video on my YouTube on that too. Yeah. But feal seizure. So, and most of the time a lot of kids that have one feal seizure might have another one. I think about 30 to 50% within that age range of six. When they're six months to five years, after five years, they probably might resolve, complete or not have any other seizures, all again. And depending on if it's a simple versus a complex fibro seizure. There is a probability that you may not have no brain well, no brain impact at all. Mm-hmm. Kids that have prolonged or complex verbal seizure may have a chance. Of having seizures or epilepsy growing up, or may have a chance of having brain development impacted, depending on how long the seizure lasted.

Chris: 29:14

Mm-hmm.

Dr Nkeiru: 29:14

But simple, preferable seizure, it's like we call it the best type of seizure to have because it completely resolves and you have no other likelihood the kid grows up like normal, nothing again going up. So it's very concerning. It's like stressful to see your child having a seizure, but it's the best seizure to have and understanding what it is. Kind of makes it a little bit easier. What we look for is what is the cause of the fever? Mm-hmm. So we're most, depending on the season, we are looking for what viruses, is it a strep throat? Do they have a ear infection, pneumonia or are you an infection as well? So that's what we are looking for. And when it's none of those, the discussion of telling the family, Hey, it's none of these, it's a feral seizure. That's where the discussion gets hard. Oh, yeah. Because everyone wants a diagnosis.

Chris: 30:02

Mm-hmm. I need it now. I need it.

Dr Nkeiru: 30:06

Everyone wants a diagnose. I'm always I, that's when I take time and say, Hey, it's probably a virus that's not completely declared itself. These are the things that it's not. This is what to expect. This is what to do going forward. I'm just gonna give them time to take it all in and ask all the questions they want 'cause. It will never, it's one thing I never say It's fine. It's not fine. Yeah. Like every seizures are just new weather, so being like benign, it is not fine. It is stressful as it

Chris: 30:33

Absolutely, and that's the thing, you know, you're a mom, you know I'm a dad. If, if, if either one of our kids had a seizure, the doctor title goes out the window. Right? Oh, yeah. And so it's one of those things for, for anyone, for any parent, it's distressing to see your child. Like that kids sometimes become apnic, they turn blue, right? And, and, and we always, I know when patients come into the emergency department, one of the questions that we always ask, because it's in the criteria for, you know, is this a simple or complex febrile seizure? How long has it been? Common answer is, but it seemed like it was forever, right? Yeah. Because, you know, it, it, it could be 10 seconds and it could seem like, you know, you're in a vacuum watching your child in that level of distress. And so, you know, we feel for you coming into the emergency department, we have very strict criteria based on like what to be concerned about. We're doing this work up in the background too. And as I always tell, my patients too. You know, you get one, right? You get one of these seizures before we, we have to start stepping up and saying, okay, maybe this isn't a simple, febrile seizure if it happens within 24 hours. So just know that we, we hear you. We, and we're there with you, and it's not okay. It's not,

Dr Nkeiru: 31:34

it's not okay. Yeah.

Chris: 31:35

Yeah.

Dr Nkeiru: 31:36

And I think one of the things I always tell families, which is actually pretty difficult, is recording the seizure. It gives you an idea of like what type of movement it is and how long did it last because you never remember like what type of seizure, like I don't know. I just know my child was not right, which is understandable. So I tell families if you can, seizures are one thing we always recommend to record 'cause it makes it easier to see what the pattern is. See this is an abnormal type that we need to like escalate and do more evaluation for.

Chris: 32:06

And that's a good point too. And you know, that'll be good for, for, for my group as well, because that's something that we can start wrapping into some of our patient follow up as well because, you know, some, some kids will, as you said, develop epilepsy, develop some form of, partial seizure or, or, or, or generalized seizure in the future. And it's good to know that. And in a lot of cases too. If they have that history, they, they may receive a a prescription for some anti-epileptic medications for home. And so all those things are, are, are really good for families to, to, to go forward in knowing. One of the things that we often will differentiate as you spoke to, was. Is this related to, you know, a virus? Is this related to a bacterial infection? Are they febrile? Because seizures can be caused by a lot of different things, and one of the things that I recently saw was a, a, an ingestion of medications. So we see toxicities you know, in pediatric patients that are coming in. My kid came in the child I took care of came in from grandma's house. Grandma, had her medications, on the kitchen table and got into it. And so I'm sure that's something that you see as well, you know, what are some of the, the, the common poisonings that you see? In kids that are presenting to your emergency department.

Dr Nkeiru: 33:15

You talked about it like grandma on the table. I feel like the fastest humans alive are toddlers. Are toddlers. A crawling child and a toddler that's like the fastest, like people alive. And I think now for us. We went through like a whole peak for THC. Mm. Like, oh, especially the gummies. Those are the ones, especially with being legalized in different places. Mm-hmm. Places with teens and young adults. These are the ones where we are seeing a lot. And as much as people always say, oh, it's not going to kill a child, it makes them so, altered and drows, your blood pressure is so low, it has a lot of cardiac, like heart effects on kids and that's one of the most common ones we see like throughout like end of last year and this year. Like any kid who looks like altered and not doing what they're supposed to do before are not acting right. We always think about THC, that's like the gummies and all the ones. Those are the ones I've been seen like a lot lately. And then like coming down to like depending on whatever medication like is in the house. As easy as like Tylenol, acetaminophen, ibuprofen, medications pregnancy related medications, folic acid, anything like colorful, exciting, not even colorful. Anything they peel for is what like kids are like grabbing and putting in their mouth. Mm-hmm. That's what we still families, like always thinking the level of a child. Like come down to the level. Anything their hands can reach. Anything exciting that seems like exciting to you? It's probably pretty exciting to them. Just like take it out high up where they cannot see or reach. 'cause once they can see, especially when they can see you taking it, they're looking at you see where does it end up? And they will climb to get it so. Any medication, anything at all that you think is unsafe, you think it's safe for you, but looks like it's not going to be safe for the kids. Mm-hmm. Just mm-hmm. Just not make it available or within eyesight for them.

Chris: 34:59

And you know, to your point, some of these medications that are not, that harmful for adults, you have to think about the dosing and as we do as pediatricians, right? Do you think of it in the milligram per kilogram dosing? Right? So you're an adult, you know, average adult, 75 to a hundred kilograms plus, right? And so. That dose for a pediatric patient can be toxic and can be, you know, for Tylenol for instance, right? Tylenol is one of the most dangerous medications in other countries that's available in blister packs. We had this conversation with my pharmacist the other day. You know, you have a blister pack of 25 tablets, right? You come here, you can get a Costco bottle of 300 for like $5. Right? Right. And so, but Tylenol is one of the, the worst toxicities that we see commonly in the emergency department because it affects your liver. We see people go into liver failure. You have to act very quickly to reverse it too. And for a kid who just, you know, all of a sudden pops it in their mouth, that can be a toxic level of ingestion if they just, you know, get a couple pills in their hand. And so it's something that, you know, to your point, you wanna make sure you have that. I to your other point about THC, I almost intubated a kid the other day who ingested a THC gummy, right? That they got over the border from Chicago, right? So totally legal in Chicago, but looked like a gummy bear. And so the kid popped it in her mouth and fortunately we were able to resuscitate her enough and admitted to the hospital. But these are things that, you know, like I said, if it's good for mom and dad, it, it, it may be maybe deadly for, for that toddler.

Dr Nkeiru: 36:22

Yeah. Yeah. And also I usually tell families too, especially during like holiday season when you have like visitors coming around, like aunties and uncles staying. I had another kid who I think the uncle was visiting an uncle, had like a statue of like THC, which family probably didn't know as uncles do. This family kept saying, there's no medication in the house. There's nothing in the house. And then they realized, oh, by the way, uncle was visiting. I'm like, okay. So that's it. That's where it's coming from. The urine was positive for THC and no one knew where it was coming from. So I would say you, you can be, you can never be an overprotected parent. Just tell like your visitors or hey, just in case you have anything, we are being safe. We have younger kids. Please do us a favor and keep things like secure. 'cause we don't have to have, we don't want to have conversations or ER visits that are not necessary because we didn't have those conversations.

Chris: 37:10

Absolutely. Absolutely one. What is one thing that you wish every parent or every caregiver knew that would keep their child outta the emergency room?

Dr Nkeiru: 37:21

I think car seats and seat belts.

Chris: 37:23

Mm. Okay.

Dr Nkeiru: 37:26

If there's nothing else we do, I mean for some, especially for someone who didn't really grow up, like using car seats and now taking care of kids, who would've been saved or who would've had less injuries if they had the right car seats or the right seat belts, car seats, and seat belts. There've been enough studies done and there's been a lot enough life saved. Like I can tell you've had families who. In the same car being brought in, but I can tell you who was in a car seat and who wasn't, who, who it like the impact is so huge that I tell families you don't even need, I mean, some families tell me, oh, we're just going down the street, like five minutes to buy ice cream. And they got impacted. And the kid and picky, I remember this kid who died and that was the story. It was just like ice cream five minutes down the road and it wasn't far. So I said. Car seats. It doesn't matter where you're going, as long as the, the car starts before you guys are leaving. Car seats, seat belts have to be on, and no child younger than 13 should be in the front seats.

Chris: 38:36

Mm,

Dr Nkeiru: 38:36

please. Like I always build families. Please. It's one of those things, you know, that can be very, very avoided. And then my second one is helmets.

Chris: 38:45

Mm-hmm.

Dr Nkeiru: 38:47

I always tell families we can pretty much like repair, like, like broken bones, lacerations, couple of things, but we cannot really repair broken brain. Like you cannot undo that helmets and like your scooter, your bicycles, I mean ATVs. I hate ATVs passion. There go,

Chris: 39:06

God, don't get me started. But I

Dr Nkeiru: 39:08

always told, oh my God, I always told my kids, listen, if peer pressure ever sets. In because you're with your friends and they have an eating, you're really excited to try it. Please wear a helmet.

Chris: 39:19

Mm-hmm.

Dr Nkeiru: 39:20

Because then I know if anything happens, you have a hip fracture laceration, your brain is probably going to be intact. So anything that has wheels, helmets, helmets, helmets. Mm-hmm. This save lives and save brains and save families, because then any family that's been impacted with an injury with the helmet not wore, and then the kid ends up like bad. There's a lot of like emotions and things that go on in families after that. Mm-hmm. So those are the two main things that I wish all families know.

Chris: 39:48

And those, those, those are right on. Right. And one of the one of the things that I think is, is, is kind of anchored to that is the approach that I've heard in the emergency department over and over again when I've given this sort of, you know precautions to parents and going forward and to even patients, a lot of times it's not even the parents. It's kinda like grandma, grandpa, you know, sitting in the back and say. Well, you know, we used to, you know, we used to, to not have to have car seats and we used to play in the backseat all the time. I remember climbing up on the dashboard and the console and all that, and I remember, right, right. But it, it times have changed, right? Like we, we, we a have better, we have a better way to track these injuries, right? So for, to all those people who are saying, you know, these never happen. It just wasn't recorded. It happened all the time. Like there is no way, there is no way, like we are seeing this frequency of injury. And you know, patients just either stayed home or they lived in rural locations where it wasn't recorded, so it happened back then. So we're trying to do all that we can to prevent these injuries because these injuries don't need to happen. This just, and these are lifelong disabilities for some of these kids and life threatening injuries that, that we can avoid. Just by wearing the helmet, just by, you know, making sure that they're in an appropriate non-modified car seat, for their, for their age and for their weight sitting in the right orientation. So you mentioned earlier on, you know, patients should be able to, you know, access those, those evidence-based, pieces of information. Not Google, not go to, you know, Instagram, Facebook, wherever. Where in your estimation can families find, you know, accurate and trustworthy information and resources about pediatric safety and pediatric conditions?

Dr Nkeiru: 41:23

Yeah, so there's a couple a A P, which is American Academy of pediatrics has like a publications, especially for those who, like a lot of like researcher things have like a website where you can get like a lot of that. But then Healthy children.org now takes that information and breaks it down into easier to understand things for both like providers and for parents. So either you going to a a p website and publications, or you're going to Healthy Children dot. And then kids health, I'm trying to figure if it's dot org or.net is actually another great one. They have like pictures, easy to understand things for like families as well. So those are the three main, I mean I'm sure they're probably, those are the three main resources. Then of course like a shameless plug by YouTube. I always actually take all those information and they kind of break it down. Absolutely. Just like experiences and information as well. Just like to communicate you through different ways. But those are the three main ones that are very helpful.

Chris: 42:15

Yeah. And, and to close it out, how can people get in contact with you? Follow you, and, and how can they find that YouTube channel that you, that you post all those amazing videos on?

Dr Nkeiru: 42:24

Yeah. So my name is the Pete, THE. PS, PEDS and er doc, both on, on YouTube, on TikTok, and then also on Instagram. My Instagram like handle is a little bit different. Doctor n Orka, but then it's the PCR doctor on almost all the platform. And then doctor incur.com, which I'm going to let you know how to like spell all of those.

Chris: 42:49

Awesome. Awesome. Well, thank you so much I appreciate you coming by and talking to us. Looking forward to, to working with you in the future, talking more. Feel free to reach out to us if there's anything that we can do to help support your work. Please continue to give us that amazing information that you're doing. It's very helpful.

Dr Nkeiru: 43:04

Of course. Thanks for having me.

Chris: 43:06

Alright. Thank you my friend. All right.

Dr Nkeiru: 43:08

Okay.

Speaker: 43:09

I wanna thank you so much for joining us here today. Thank you to Dr. Nkeiruka for dropping some much needed pearls about pediatric emergency medicine, as well as some of her insight from being a global provider on vaccines, as well as the importance of evidence-based medicine. In recent years, there has been an attack on evidence-based medicine as well as the scientific approach that we apply as providers. And like Dr. Nkeiruka said this is something that we need to continue to fight as physicians, as allied healthcare providers in order to promote the scientific method as well as in order to promote. Wellness amongst our communities. We have to have a standardized, regimented way that we go about this in order to promote public health and to prevent preventable diseases in this instance. Looking forward to seeing you on our next episode, which should be upcoming soon. And with that being said.