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Hot Seat #229: Short of Breath, What is the right test?

Case by Jessica Williams MD, Children’s National PEM Fellow 18 yo female presents with cough for the past 2 weeks now complaining of shortness of breath for the past 2 days. She also endorses tactile fever for the past 2 days. No vomiting but feeling nauseous. Normal urine and stool output. Up to date on […]

Hot Seat Denouement #228

This week’s case focused on a child with fluctuating apnea and altered mental status ultimately found to be due to ingestion of marijuana. The diagnostic dilemmas centered on the appropriate respiratory support and decision to perform a lumbar puncture. The differential for unexplained periodic apnea and AMS is quite broad covering a range of neurological, […]

Hot Seat #228: Wake Up!

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 […]

Hot Seat #227 Denouement

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 […]

Hot Seat #227: Tension at the Top

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 […]