Case by Seth Gerard MD, INOVA PEM Fellow A 2-year-old previously healthy male presents to the ED with approximately 3 hours of altered mental status and twitching. Started with altered mental status at around 10:15, and was noted to also have significant jerking movements and intermittent agitation. Family adamantly denies any recreational drug use or […]

This week’s case discussion focuses on a partially vaccinated 14-month-old presenting with a fever and a bulging fontanelle. Key discussion points included the choice between ultrasound and CT imaging, the necessity for empiric antibiotics, and the considerations for performing a lumbar puncture. Assessing the fontanelle when the child is calm is essential, as a bulging […]

14-month-old unvaccinated child presenting with 1 day of bulging fontanelle. Two days prior to presentation patient had 3 episodes of non-bloody non-bilious emesis. In between these episodes she did tolerate PO without emesis and was acting at her baseline so family monitored her at home. Yesterday,  she was still having normal PO intake, was no […]

This week’s case highlights a case of an adolescent with neck swelling. All learners agreed that the first step was to obtain imaging. The choice of imaging largely depends on the clinician’s suspicion based on the history and physical examination. In this case, there was potential trauma to the neck which may increase the risk […]

Case by Nicholas Dimenstein MD, CNH PEM Fellow An 11-year-old male was brought into the ED by his parents with concerns that another player may have stepped on his neck during football practice. His neck is slightly swollen. He complains of a minor headache that started on the drive to the ED. Denies neck pain, decreased ROM, nausea, vomiting, […]