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Hot Seat #230: Snooze Clues

Case by Christina Rojas MD, Children’s National PEM Fellow A 4-year-old male with a history of ITP presents with vomiting and increased sleepiness. His mother reports that he had three days of nasal congestion, and then today had 4 episodes of NBNB emesis. This morning, he seemed more sleepy than usual, however was still responding […]

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 […]