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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 #206: A Hazy Headache Hypothesis

By Alicia Rolin, MD HPI: 20YO female with no significant past medical history presenting with new daily headache x 1 month.  She has no history of headaches but reports new headaches since coming home from college for Winter break. She reports the pain is bitemporal and throbbing. She endorses occasional blurred vision, sensitivity to light, […]

Hot Seat #205: Denouement

This week’s case features a baby with altered mental status, transferred to us for further workup and management. Our discussion focused mostly on the broad differential here, including toxic ingestion, seizure, arrhythmia, reflux, anaphylaxis, FPIES, and others. It highlights the difficulty in disposition for patients who are back to baseline after an extensive workup that […]

Hot Seat #205: What’s Up, Baby?

By Walter Palmer, MD; Children’s National Medical Center HPI: 7 mo previously healthy girl presents to an outside hospital with altered mental status.  She was in her usual state of health in the morning with no recent illness.  She ate cheese for the first time around 11am, which was immediately followed by many episodes of […]

Hot Seat #204: Tonsil Turbulence

By Dr. Kala Frye Bourque, Children’s National Medical Center HPI: A healthy 18-month-old male presents with his mother and grandmother. About 30 minutes PTA patient was playing in mother’s bedroom while she was doing laundry. Mother heard gagging and looked down to find patient with metal hanger in his mouth. Mother pulled hanger from mouth […]

Hot Seat #203: 28do with abnormal movement

The patient is a 28 day old ex-FT female presenting with abnormal movement. When the patient was waking up from sleep this AM, parents noted a period of bilateral upper extremity stiffening and foaming at the mouth with associated R sided head deviation and eyes rolling back. The episode lasted < 1 min. Patient was […]