Case by Nico Dimenstein, CNH PEM Fellow 17 year old female, history of G/C 4 months ago, treated with resolution of symptoms, here with several days of tactile fevers, body aches, and sores on her lip and in her mouth. Endorses headache, mild runny nose, cough, and oral ulcers. Has never had oral ulcers before, denies any other areas with ulcerations or […]
Hot Seat #257 Denouement
IN ERROR BELOW* This week’s case highlights the dilemma of being the sole overnight provider in an ED without SW or child psychiatry immediately available. Although the patient has some protective factors, she also has a few troubling features. It can be challenging to determine how much risk you are willing to accept when making a plan […]
Hot Seat #257: Close Call
Case by Fatima Sallman, CNH PEM Fellow As the sole ED provider overnight in a community peds ED, you are seeing a 12-year-old female with hx of depression and anxiety who was brought in by her parents after she disclosed to them that she took seven 200 mg ibuprofen tablets approximately 2 hours ago. She denies abdominal pain, nausea, or vomiting. […]
Hot Seat #256 Denouement
This week’s case highlights the challenging aspects of a complete physical exam on irritable patients and how to best complete urgent sedation. We discussed various routes (IM, IN, IV) as well as the risks and benefits of different sedatives based on the indication. The patient was sedated with IM ketamine with IV access obtained during […]
Hot Seat #256: Let’s Air This Out
Case by Maria Elena Arrate, CNH PEM Fellow 11 year old female with history of developmental delay, non-verbal presenting for suspected FB ingestion. Per patient’s father, the patient became distressed in the late afternoon where she started grabbing his hand and putting it on her chest and throat while crying. Father reports patient then laid down and noticed her face turning red, while appearing to have difficulty breathing. Denies any drooling. EMS was called and on […]