Case by Maria Elena Arrate, CNH PEM Fellow A 12-year-old girl with hx of a thyroglossal duct cyst status post excision 1.5 months ago is presenting with 2 days of fever, headache, nausea, and a new diffuse rash. The excision was complicated by neck swelling at the surgical site despite treatment with Augmentin and subsequently […]
Hot Seat #264: Acute or Chronic?
Case by Brittany Fitzpatrick, CNH PEM Fellow 8yo F w/ PMH of chronic active EBV (CAEBV) complicated by HLH, s/p BMT complicated by EBV-related relapse and GVHD, now presenting with acute on chronic abdominal pain. Mom says patient has had waxing and waning abdominal pain for years since BMT, but it has acutely worsened this week, currently rated as 8/10 in severity. Reported a fever (100.8) 6 […]
Hot Seat #263 Denouement
This weeks case highlights the challenges of ED management of neonatal seizures. We discussed the utility of head US vs. CT brain when able. We also discussed varying levels of comfort with doing an LP in a frequently seizing baby without respiratory symptoms or desats. We considered appropriate thresholds for AED administration in self-resolving seizures. […]
Hot Seat #263: Seize the Day
Case by Gabby Jasmin, CNH PEM Fellow You get a call about a trauma transfer from OSH. 2-week-old ex full-term female born NSVD presenting from PCPs office with concern for seizure-like activity. Mom states that episode started last week and has been increasing in frequency. She describes the movements as left arm stiffening and facial twitching. During these episodes the infant will turn very red and sometimes spit […]
Hot Seat # 262 Denouement
This weeks case highlights the challenges of clinically clearing a c-spine vs. radiographic findings. We discussed the utility of a c-collar in a toddler when you are not concerned about an unstable cervical spine injury. We also discussed the challenges of having CT information from an outside hospital in a patient you may not have […]