This week’s case highlights the challenging aspects of determining potential sepsis in patients with complex conditions such as multiple sclerosis. We discussed differing clinical styles of how we determine if a patient is a “sepsis yellow”, “sepsis red” and “sepsis unlikely”. We also discussed how these terms can help establish a shared mental model for […]
Hot Seat #254: Short on Red, Big on Symptoms
Case by Adenike Animasaun, CNH PEM Fellow Patient is an 18-year-old female with a history of multiple sclerosis on ofatumumab presenting with one week of progressive fatigue and hypotension. Parents report home blood pressures as low as 90/70 with associated tachycardia to the 120s and increasing lethargy. She has had decreased oral intake, two episodes of NBNB emesis today, […]
Hot Seat #253 Denouement
This week’s case highlights the difficulty of interpreting hypothermia in an infant as environmental vs. sepsis. We discussed clinical clues such as the patient being well appearing (less likely to do work-up) and lower levels of risk tolerance in neonates/newborns (more likely to do a work-up). We also discussed what a work-up would entail and […]
Hot Seat #253: Baby, It’s Cold Outside
Case by Jamal Alanni, CNH PEM Fellow 12 month old infant without significant past medical history presenting with 1 day of clear rhinorrhea and barky-like cough in setting of 10 days of decreased oral intake. They were previously breastfed but since weaning off they’ve had less oral intake and sometimes refusing bottles. Last night they took 5 oz of breastmilk through the bottle. During the past 10 days, they continued making […]
Hot Seat #252 Denouement
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 […]