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 #200: Tip-Toeing Around the Tap
By Dr. Timothy Carr, Children’s National Medical Center You receive a call about a 2 ½-month-old girl presenting to an outside hospital for 2 days of fever, cough, nasal congestion. Tmax at home 39.5 C. Patient has been feeding, voiding, stooling normally. No respiratory support needed. Patient with no medical problems. No regular scheduled medications. […]
Hot Seat #199: A Tribulation of Tonsils
23mo presents with increased WOB in the setting of 1 day of fever (tmax 101.5) and URI symptoms. Mom noticed some mild swelling of the right side of his neck. No vomiting or diarrhea. Normal PO intake. Normal UOP. Mother reports snoring and chronic nasal congestion at baseline. PMHx: Wheezing in setting of previous illness, […]
Hot Seat #198: A Damp Dilemma
By Brandon Kappy, MD, Children’s National Hospital You receive an EMS notification about a 5-year-old M being brought in following a near-drowning event that occurred in the last 30 minutes. Per EMS report, patient climbed over a fence and jumped in a pool, despite not knowing how to swim. His mother does not know how […]
Hot Seat #197: 13-year-old with knee pain
13-year-old female initially presented with right knee pain 2 weeks ago and had an X-ray that showed a distal femoral epiphyseal lesion. She then had an outpatient interventional radiology-guided biopsy of it 6 days prior to today. The patient reports her pain was controlled well initially. However, over the last 24 hours, she has had […]
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 […]