Brown Emergency Medicine Blog — BROWN EMERGENCY MEDICINE BLOG

This is Not the Appendix You're Looking For

A previously healthy 11 year-old male presents to the ED with three days of lower abdominal pain. The patient was evaluated at an urgent care center prior to arrival and was sent to the ED to “rule out appendicitis.” The patient reports intermittent “stabbing” pain that was initially suprapubic, but moved to the right lower quadrant today. The patient states the pain comes and goes without a clear trigger, but he has been able to eat normally and go to school. His mom became concerned today when they were about to eat dinner and the patient had an episode of severe pain that caused him to lie down. His mom gave him acetaminophen with some relief. He has not had fever, nausea, vomiting, or diarrhea. He has no sick contacts. He denies dysuria and penile discharge…

Radiology, GU, Pediatrics, UltrasoundJessie WernerNovember 29, 2019Emergency Radiology, UrologyComment

When It Comes to Ticks, It’s Okay to Make RASH Decisions

An otherwise healthy 16 year-old-male presents to the Emergency Department (ED) with a rash on his chest that began one month prior to presentation. The patient reports that his dad noticed the rash today, prompting him to present to the ED. The patient denies any systemic symptoms including fevers, nausea, malaise, or abdominal pain. He states the rash is painless and does not itch. He has no memory of a tick bite but does spend time outdoors…

Pediatrics, Infectious DiseaseJessie WernerNovember 8, 2019Pediatrics, infect, Community EMComment

Intranasal Medications

A 7 year-old girl presents after falling off a jungle gym. She has a visible deformity of the left humerus and wrist. She won’t let the nurse get close enough for a blow-dart, let alone an IV, and your attending slaps the IO kit out of your hands as you desperately try to boost your procedure numbers. She needs pain relief. Now what?

Pediatrics, Medical EducationDaniel ColemanOctober 11, 2019#FOAMed, IntranasalComment

A Bowel Inside a Bowel: Intussusception

A 14 month-old female with no significant PMH who presented to the Emergency Department with vomiting. Per mom, patient was well yesterday, but today has been refusing food, crying and vomiting. Patient has had no known sick contacts and her vaccinations are up to date. A review of systems was performed and was otherwise negative…

GI, Pediatrics, UltrasoundChloe SummerlandSeptember 20, 2019#FOAMed, #PEM, #POCUS, #IntussusceptionComment

Non-Accidental Trauma

A hypothetical 7 month-old infant presents to the emergency department for mild respiratory distress. There is no recent illness or symptoms to explain the infant’s tachypnea and mild hypoxia. There is no visible bruising on exam. The parent states that the infant is starting to pull to stand but does not yet cruise. They have had several falls onto their tile kitchen floor. The CXR (below) is read by the radiologist left posterior rib fractures in ribs 4-8…

Orthopedics, PediatricsKelly WongAugust 2, 2019Orthopedics, PediatricsComment

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