E M Pearl, May 18

3yo male h/o RAD presents with a nasal foreign body.  After a few conservative efforts to remove the FB, it is apparent the  child will not be able to cooperate with further attempts. A line is placed and 1mg/kg ketamine is given IV. While loosening the object with a blunt-tipped probe, you notice the suddenRead more

E M Pearl, May 15

Courtesy of Dr. Elikashvili.   20 month old female is BIBEMS after seizure at home just prior to presentation.  Mother describes “10 minutes” of what sounds like generalized tonic-clonic movements. No h/o seizures.  Child was born full term and 18 month vaccines UTD.  She reports 2 days preceding fever, no URI, cough, diarrhea, rash, butRead more

Daily Em Pearl, 4/28/12

A teenaged woman presents at 32weeks gestation, c/o fingertip pain after experiencing a brief electric shock at home. How do you evaluate and care for this patient?  Read more

Daily Em Pearl, 4/20/12

A young woman precipitously delivers a 34wk gestation neonate in your ED. The mother is physically doing well and you turn your attention to the neonate, whose HR is 105 but falling. You prepare for a possible neonatal intubation and alert the NICU. Peds is on the way and you begin your resuscitation of theRead more

Daily Em Pearl, 4/19/12

A 6yoM is brought by his guardian for intermittent crying, c/o abd pain for the past two days; he has vomited 4times over the past 2days. He has had no fever and has never had anything like this before.  At home his urine has been dark, and this morning, possibly bloody. He has no medicalRead more

Daily Em Pearl, 4/17/12

Today’s pearl is courtesy of the AM report. When evaluating the lethargic pediatric patient there’s lots to consider. Here’s a mnemonic, that if you can remember it (write it down) could be elucidating.   Carbon monoxide poisoning Overdose Metabolic derangement/disorder Abuse/alcohol/asphyxia Trauma Organic acidosis (that’s metabolic d/o again) Seizure/shock Encephalopathy Psychiatric disturbance Acidosis/alkalosis Tumor Insulin/intussusception EndocrineRead more

daily EM pearl 4/11/12

You are caring for a 7mo child who is not moving the LUE; a plain film shows a fracture. Child maltreatment is high on your differential. You want to order a skeletal survey and your medical student wants to know precisely what you’re looking for on your survey. You say…  Read more

Daily EM Pearl 3/27

A 6 day old baby presents pale and lethargic. HR 200, BP undetectable, O2 saturation 90%, RR: 40, finger stick 20. You give dextrose but symptoms do not improve. You suspect congenital heart disease and confirm this with a hyperoxia test. You then administer an intervention but the baby subsequently becomes apneic. The patient isRead more