This week’s case highlights the challenging aspects of how much work-up should be done in an ED setting for issues that are not a part of the chief complaint (this case was fever and URI symptoms consistent with a viral etiology). We discussed how our some of our patient population has limited access to care, […]
Hot Seat #255: URI or Are you Alright?
Case by Brittany Fitzpatrick, CNH PEM Fellow 21 month old male presents with fever and URI symptoms x3 days. In addition to congestion and fussiness, parents have also noticed intermittent wheezing while sleeping. Two episodes of emesis 2 days ago. Parents have noticed a mild decrease in wet diapers but tolerating PO. No diarrhea, however he had a looser stool last night, and […]
Hot Seat #254 Denouement
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 […]