Herpes Encephalitis

A 70 year-old male, with a past medical history of hypertension, gastroesophageal reflux disease, chronic lymphocytic leukemia on Ibrutinib, and coronary artery disease, presented with right hand weakness since waking that morning. He reported that he felt the strength of his grip was not at baseline, and his wife also noted that, while eating breakfast, the patient dropped his bagel, a dish towel, and his utensils. His last known well was 10:00 PM the night before, although he also endorsed two weeks of persistent right hand numbness and burning paresthesias in his right hand. He denied headache, fever/chills, chest/back/abdominal pain, nausea/vomiting, urinary symptoms, or diarrhea, as well as any visual symptoms, speech changes, or gait problems…

Community EM, Infectious Disease, NeurologyKelly WongSeptember 21, 2020herpes, herpes simplex virus, encephalopathy, seizure, Infectious DiseaseComment

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

Money Minutes for Doctors #22 - The Side Gig

Money MinutesKristina McAteerAugust 31, 2020Comment

Brown Sound: Necrotizing Soft Tissue Infection

A 60 year-old male with history of poorly controlled diabetes, congestive heart failure, chronic kidney disease, and a prior MI presented as a transfer from an outside hospital for surgical management of suspected necrotizing fasciitis/Fournier’s gangrene. He reported symptoms of diarrhea, nausea, vomiting, and severe pain in the scrotum and perineum for several days. This began after he sustained a small cut to the area. He denied fevers, urinary discharge, respiratory symptoms, chest pain, but did endorse chills and night sweats…

Ultrasound, GUHannah ChasonAugust 31, 2020Ultrasound, fournier's gangrene, Necrotizing Fasciitis, surgery, UrologyComment

CASE:

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