The Trouble with Wheezing

4 month-old M PMH low birth weight presents with a 3 day history cough and runny nose.  Today his mother reports a low grade fever.  His immunizations are up to date. He has no known sick contacts, but he attends day care. His respiratory rate is 39 and is coughing frequently. On lung exam heRead more

Get That Line

Vascular access in ill neonates who present to the ED can be challenging. Umbilical vein catheterization can be a life-saving option. The umbilical vein remains patent and viable for cannulation until approximately 1 week after birth.Read more

5 y/o F presents to the ED feeling “uneasy.” She is noted to have a pulse of 140 and BP of 180/110 and is profusely sweating. She is on imipramine for bedwetting, no other PMH. Pupils are PERRL. Exam is otherwise unremarkable. CBC, BMP, UA are negative. When considering a toxidrome, what is your differential?Read more

My Face is Swollen!

A 15yo girl comes into your ED complaining of unilateral facial swelling that started this morning as a little bit of swelling under her R ear, and 8 hours later, is now her entire R cheek. No fevers/chills. ROS otherwise negative. VS normal. Exam with induration to the R cheek, non tender, no overlying erythema.Read more

Pediatric Fever & Rash

A 3yo M no sig PMH, IUTD, comes into your ED with complaint of 3 days of fevers, diffuse rash worst on the R hip, mild limp, N/V, no urine output today, and lethargy. On exam, found to be febrile to 40.1, tachy to 197, BP 90s/50s, sat 96%. Irritable but awake. HENT with bilateralRead more

6 Month Old Wheezer. Trial of Saline and Albuterol Nebs, Right?!

PEM fellow Dr. Michelle Vazquez presents a case of: A 6 month old boy comes to the ED with an elevated respiratory rate and lots of wheezing on exam. He had a tactile fever at home and in the ED his temperature is measured at 100.4F. His oxygen saturation is 90% on room air. ThereRead more

Don’t Forget About the Kids….

@JoePinero Quick Case: 17 mo M child presenting with painless bright red rectal bleeding x 1 day. Benign physical exam. Afebrile, with stable vitals and normal labs. Dx: Meckels Diverticulum T99 scan for diagnosis (Sensitivity 85-97%, Specificity 97%) Surgical treatment: Indicated in severe cases, significant blood loss, persistent abdominal pain, refractory to medical treatment. MostRead more

Pediatric Hypoglycemia

A 3 year old M presents to the ED with lethargy.  Fingerstick is 38. How do you give this kid sugar??Read more

Head Injury in Hemophilia

An 8 year old female is brought in by her mother after falling off her scooter one hour ago. She was not wearing a helmet, and hit her head on the ground. Patient and mother deny LOC. On exam, she is well-appearing, playing with her mother’s cell phone. She has a mild hematoma over herRead more

Daily Pearl 11/4

What 2 classic radiographic findings are exemplified in these images? What clinical diagnoses are they individually pathognomonic for? What clinical presentations would you expect? A BRead more