ERROR in question poll below This week’s case highlights the importance of adjusting your clinical assessment and typical algorithms to the needs of each patient. Our patient with OI has a high risk of fractures with routine labs draws and care. We should be thoughtful about what we are most concerned about, how the patient […]
Hot Seat #252: “O.I.” was in an accident
Case by Sarah Benett, CNH PEM Fellow 19 year old female with a history of Osteogenesis Imperfecta Type VIII and restrictive lung disease presenting with rib pain after an MVC that occurred earlier that day. Mom reports they were traveling 55 mph on the highway when they were hit on the right side by another […]
Hot Seat #251: Oh…Variable Decisions
Case by Gabby Jasmin, CNH PEM Fellow 10 year old female with no significant medical history transferred from an outside hospital with LLQ pain. Pain started 1 day ago and is intermittent. Associated symptoms include nausea and vomiting. Denies any fevers, or URI symptoms. No history of constipation and reports daily regular bowel movements. No sick contacts at home or history of travel. Patient was taken to outside hospital and CT abdomen/Pelvis demonstrated “prominence of left ovary is likely related […]
Hot Seat #250 Denouement
This week’s case highlights the importance of considering a bleeding disorder in scalp hematomas. Some scalp hematomas will develop into a worsening hemorrhage causing significant blood loss. Good return precautions and monitoring of the size of the swelling is necessary to discuss with parents. Admitted to floor w plan for MRI/MRV/MRA in AM. MRI/MRV w […]
Hot Seat #250: Bogged Down
Case by David Branson, CNH PEM Fellow 7 yr old previously healthy M presenting for 2nd visit w scalp swelling after head trauma. Roughly 2 weeks ago, he was at school when he ran into a piece of playground equipment while playing tag, hitting his head on the equipment. He did not initially say anything, but parents noticed head swelling roughly 1 week later which prompted ED visit. At the initial visit, his exam showed boggy […]