A 4 year old child presents to the ER with 7 days of a measured fever, along with a progressive diffuse red maculopapular rash over the trunk and extremities. On exam, the patient has a conjunctivitis and erythematous oral mucosa. What diag…
A 50 year old patient with HIV, HCV cirrhosis presents to the emergency room with subjective fevers and generalized abdominal pain with tenderness. As part of your workup, you plan for a diagnostic paracentesis. On ultrasound imaging, the p…
When assessing for a difficult airway what does the LEMON acronym remind us to check? In a study, only three factors from LEMON are associated with a difficult intubation, which are they?
Thanks to Brittany for this excellent Peds pearl. A 4 year old boy presents with a fever and a one-day history of rapidly worsening limp at the LLE, now with complete refusal to bear weight or range the L hip. You are concerned about a wide…
28F presents with two months of intermittent fevers and a new murmur. You suspect infective endocarditis. With this subacute presentation, how many blood cultures should you order? How far apart? What empiric antibiotics are indica…
Thanks to A.Hill for today’s pearl: 19M presents with fever and rash on palms and soles x1 week. Vitals: Temp 101 HR 105 BP 130/80 RR 12 O2 100% What is the differential for rash on the palms and soles? Disseminated gonococcus Rocky m…
A patient presents after an episode of syncope vs seizure. Can a serum prolactin level be helpful in differentiating the cause?
Thanks to PEM fellow Brittany for today’s cases. A 1 week old presents with cyanosis and sweating with feeds. No history of fever, preceding illness. O2 sat is 85%. Child is placed on 100% O2 but O2 sat does not improve. What are some…
23yo M presents with 2 days of substernal CP associated with fevers and dizziness, he called EMS for a near syncopal episode today. His triage vitals: Temp: 102.1 HR: 105 HR: 126/64 RR: 18 O2: 99% RA Exam: unremarkable exam: no murmurs/rub…
A 20yo M is BIBEMS after falling from a scaffold at a construction site. He has signs of head trauma. Upon arrival his VS are: T=98.9 HR=75 BP=185/90 RR=12 o2 Sat=99% on NRB His neuro exam: PERRL, moving all extremities eyes open to pain m…
The first three pearls from this week did not go out via email, although they are on sinaiem.org Today’s pearl: A 45F presents with 3 weeks of CP. Her vitals: Temp 36.8C HR 71 BP 95/65 RR 18 O2 98% RA Her exam is unrema…
Tip of the hat to Raj Patel for inspiring this clinical question. 26F h/o lupus is brought into resus for positive sepsis screen at triage. Patient c/o pleuritic CP, SOB, headache, n/v starting today. Vitals are 101.3 140 74/55 2…
An 18 year old female presents to the peds ED after an episode of witnessed syncope. Pt was hiking when had sudden LOC, no preceding symptoms. She now feels well and denies CP and palpitations. No prior episodes. No OCP use or other PE ris…
Thank you to Papa Hernandez for this fascinating case. 37F 10 weeks pregnant (by LMP), asthma presents with 1-2 weeks of SOB. Extertional, +orthopnea, + bilateral LE edema. Has yet to initiate prenatal care. Her vitals at triage: 97…
A 32F who is 14 weeks pregnant presents with intermittent shortness of breath x 1 day. She has no h/o DVT/PE. Vitals 98.9 100 105/70 18 99% on RA. Clear lungs, no calf asymmetry on exam. You are concerned about PE. How should you procee…