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Hot Seat: You’re as Cold as Ice

Case by: Masouma Mohamed, PGY4, Inova PEM fellowship HPI: 50 day old, ex FT, born to GBS negative mom, presents to the ER with low temperature. The child was doing well until 4 hours prior to presentation, when mom noticed that she felt cool to touch with forehead sweating. Mother checked a rectal temperature, and […]

Hot Seat #181: 5-year-old with difficulty walking.

HPI: 5-year-old female with a non-verbal autism presents to the ED due to progressive refusal to bear weight over the past month.     Patient was initially seen three weeks ago by her pediatrician for LLE pain. At that visit the CBC, CK, ESR, and CRP were all normal. She was incidentally found to have Vitamin […]

Hot Seat #162: A Patient with Inadequate Imaging

HPI: 16-year-old male with no pertinent past medical history presents for medical clearance with police.  Earlier today he was in a physical altercation and was subsequently arrested.  During the altercation, he notes that he was punched multiple times in the face, and ultimately thrown to the ground. He currently reports pain in his jaw and […]

Hot Seat #157: 10 day old with elbow swelling

CC: 10 day old girl with elbow swelling HPI: 10 day old ex FT girl presenting with left elbow swelling and decreased movement of left arm. Parents report that in the middle of the night, they noticed she was not moving her left arm the same way she was her right. Waking every 1-3 hours […]

Hot Seat #196: 18-Year-Old with Allergic Reaction

By Chris Kovaleski, Inova Children’s 18-year-old previously healthy girl is being brought into your ED by EMS. Per bystander report, the patient was running around a track and felt her throat “was weird,” so she took 25 mg PO diphenhydramine. By the time EMS arrived, patient was found to be unresponsive with facial swelling and […]

Hot Seat #195: 10-month-old with diarrhea

10-month-old ex FT F presents with subjective fever and bloody diarrhea.  Patient with 3 days of non-bloody diarrhea, however, 1st day of bloody diarrhea was day of ER presentation.  Caretaker describes it as bright red streaks of blood and mucus mixed in with stool. Caretaker is unsure of stool frequency but approximates it’s with every […]

Hot Seat #194: A Pedestrian Pickle

You receive a call from EMS, who is on-scene with a 13-year-old female who was a pedestrian struck by a car reportedly traveling at 15mph, requesting assistance with destination. She is amnestic to the event. EMS reports that she is currently ambulatory, alert, and oriented. She sustained lacerations to her face and is complaining of […]

Hot Seat #193: 6 yo female with SOB

Masouma Mohamed, PGY4, INOVA Children’s Hospital Fellowship HPI:  A 6-year-old female presents with difficulty breathing accompanied by her grandfather. For the past 3 days, she was not feeling well and was noted to be breathing quickly. No fever, vomiting, or diarrhea. She was seen by her PMD this week and started on Augmentin and cyproheptadine […]

Hot Seat #192: A Sore Throat Quandary

Case by Dr. Christina Rojas, MD HPI: 20 y/o female with a history of migraines presents with fever, sore throat, and headache for 1 day. No vomiting, diarrhea, cough, or shortness of breath. She has still been able to manage her secretions and drink liquids despite throat pain. Headache is nonfocal and feels similar to migraines […]