This week we highlighted a case of persistent emesis without diarrhea. The differential for persistent emesis is broad and can be difficult to parse out. The crux of the decision is to determine how much emesis is too much and what portion of the work-up should be completed in the emergency department In this specific […]

Case by Alicia Rolin MD, CNH PEM Fellow 10-year-old previously healthy male presenting with 10 days of non-bloody, non-bilious emesis. Reports 7-10 episodes of emesis per day. Initially only after eating, but now spontaneously throughout the day. Not worse in the AM. No diarrhea. Intermittent 8/10 dull non-radiating epigastric abdominal pain. No identifiable trigger. Does […]

This week’s case highlights the presentation of a 14 yo M with stable asymptomatic hypoxia. Fellows noted that polycythemia on the initial CBC could be secondary to chronic hypoxia. CXR appeared overexpanded with air bronchograms with possible small RLL consolidation and prominent hilum L>R with asymmetric vasculature. Fellows brought up if his pulse ox had […]

Case by George Nassar MD, Inova PEM Fellow A 14-year-old male, with no significant past medical history is brought by EMS to the ER from an outside urgent care because of hypoxia. He has had low-grade fevers (Tmax 101 F) and a productive cough for 2 days. At the urgent care, he was noted to […]

GI consulted and upon further examination found presentation and physical exam findings concerning for cutaneous manifestation of Crohn’s disease. Labs were obtained and the patient was found to have normal CBC, CMP, ESR, CRP, uric acid, and LDH. Negative serum beta hCG. With unremarkable lab work, GI recommended outpatient follow-up and dermatology outpatient for the […]