Kawa-shocky

The patient is a 5-year-old female with a past medical history significant only for torticollis who presented to the emergency department with fever, emesis, diarrhea, fatigue, and rash. The patient began having fevers to 102 degrees Fahrenheit five days prior to arrival. The patient’s mother reported that four days ago, the patient began having diarrhea and non-bloody, non-bilious emesis. Two days ago, she began having decreased PO intake, continued fevers and emesis, anuria, and bilateral neck pain. The morning of arrival, the patient’s mother noted a rash on the patient’s back and bilateral conjunctival injection. She brought the patient to her pediatrician’s office, who sent her to the ED for further evaluation and management…

Pediatrics, Cardiology, Critical Care, ResuscitationLindsay MillerSeptember 28, 2020Kawasaki, Rash, Shock, PediatricsComment

Metabolic Crisis - The ED Doc’s Approach

A 6-year-old female presents with emesis and fatigue. The patient’s mother reports her daughter has a history of Maple Syrup Urine Disease. The day before presentation, on routine urine check, the patient had 2+ ketones in her urine. The patient consumed a protein restricted diet, which initially cleared the ketones. However, on the morning of presentation, the patient began vomiting, appeared more lethargic and had 4+ ketones in her urine. On arrival, she was tachycardic and tachypneic. Her exam was significant for a tired appearing female with dry mucous membranes and poor skin turgor.

Pediatrics, ResuscitationMegan PerrySeptember 14, 2020Metabolic Disorders, Maple Syrup Urine Disease, PediatricsComment

A Case of Abnormal Movements in an Infant

Austin Quinn, MD, and Meghan Beucher, MD

CASE:

The patient is a 4 month-old ex-full term fully vaccinated otherwise healthy male who presented to the ED with one week of abnormal movements. The patient's mother stated that over the past week he had had increasingly frequent clusters of 5 or 6 episodes of flexing his hips and arms in toward his trunk, accompanied by abnormal eye movements with upward deviation and head drop. She sent videos to the PCP who felt it was from gas pain and started the patient on simethicone, without improvement in symptoms. Mother commented that they appeared to happen more often before sleep, but could happen when the patient was wide awake. He appeared to remain conscious throughout the episodes and would often cry afterwards.

Pediatrics, NeurologyAustin QuinnSeptember 4, 2020pediatrics, pediatric neurology, neurology, seizure, abnormal movement, spasmsComment

A Toddler’s Tibia: Common Yet Obscure

A 3 year-old male presents to the pediatric emergency department with leg pain. Prior to arrival, the patient had been at daycare and was found crying, reporting pain to his right leg. The daycare staff denied any specific trauma and noted that he had been playing happily throughout the morning. His parents were understandably concerned and dad reported that this had been his fourth visit to the emergency department for fractures since he started walking at 12 months of age…

Pediatrics, Sports MedicineDerek LubetkinAugust 7, 2020Pediatrics, OrthopedicsComment

Paternalism and the Pediatric Emergency Department

If your hospital system is like mine, it has a dedicated pediatric emergency department. A place connected to a larger children’s hospital, where all of the providers, including nurses are certified in pediatrics. They also offer a whole host of other pediatric support, like child life specialists, without whom I would not be able to suture a laceration or obtain cerebrospinal fluids samples. All of the people have one goal, the safety and well-being of the child. This system, as you might expect, fosters a unique culture of medicine; a culture which I assert is heavily steeped in paternalism…

PediatricsRussell PrichardJuly 24, 2020pediatrics, paternalismComment

CASE:

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