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What’s Your Diagnosis? a 9-month-old infant gasping for air September 30, 2019

Posted by Andy Jagoda, MD in : What's Your Diagnosis , 1 comment so far

But before we begin, check out if you got last month’s case right, about the 11-year-old boy with acute abdominal pain. Click here to check out the answer!

Case Presentation: an 9-month-old infant gasping for air

As your shift is winding down at 4 AM, a mother brings in her 9-month-old infant, whom she describes as “gasping for air.” The baby has had a runny nose and cough for a few days as well as a low-grade fever, but now he is breathing rapidly and wheezing, with lower intercostal retractions.

The mother states that the infant has had wheezing in the past, and she asks if he might have asthma since “it runs in the family.” She also indicates that in the last 12 hours, he has not taken his usual amount of fluids.

His oxygen saturation level is 87% on room air.

You begin to think… should I treat this as reactive airway disease, asthma, or bronchiolitis? When should I give the patient albuterol, nebulized epinephrine, or oxygen? Does the infant need steroids? You also wonder whether this patient is going to tire and require assisted ventilation or whether there are any other alternatives to intubation.

Leave your solution in the comments below and review the issue to find out what was the authors’ recommendation.

Not a subscriber? You can find out the conclusion and if you got it right, next month when a new case is posted, so stay tuned!

Click to review Pediatric Emergency Medicine Practice

What’s Your Diagnosis? Nonconvulsive Status Epilepticus: Overlooked and Undertreated September 30, 2019

Posted by Andy Jagoda, MD in : What's Your Diagnosis , 1 comment so far

But before we begin, check out if you got last month’s case, on assistance with air travel emergencies, right. Click here to check out the answer!

Case Presentation: An 81-year-old woman presents with 1 day of behavioral changes

An 81-year-old woman presents with 1 day of behavioral changes. On examination, she is disoriented, with no focal neurologic findings and no evidence of seizure activity. Her medical history is remarkable for anxiety, arthritis, and hypertension; she has no history of stroke, trauma, or immunocompromise. Her medications include furosemide, lorazepam, and acetaminophen. After an extensive workup in the ED including ECG, CBC, CMP, UA, and
brain CT, all of which were normal, she was admitted to the floor.

You wonder: Is there something you forgot to consider in your differential diagnosis?

Leave your solution in the comments below and review the issue to find out what was the authors’ recommendation.

Not a subscriber? You can find out the conclusion and if you got it right, next month when a new case is posted, so stay tuned!

Click to review this Emergency Medicine Practice Issue

Brain Teaser: Signs of pneumothorax when seen on thoracic ultrasound September 13, 2019

Posted by Andy Jagoda, MD in : Brain Tease , add a comment

The pediatric patient is arguably more suited for emergency ultrasound than the adult patient. Children generally have a smaller body habitus than adults and, therefore, less tissue for the ultrasound beams to penetrate. This often leads to clearer images of the different organ systems, which should yield better diagnostic accuracy.

Test your knowledge and see how much you know on pediatric ultrasound!


Did you get it right? Click here to find out!

The correct answer: D.

Review this Pediatric Emergency Medicine Practice issue to get up-to-date on POCUS in the ED.

Already a subscriber? Earn CME for this topic by logging to take your CME test.

Clinical Pathway for Management of Hemorrhage in Patients Taking Direct Oral Anticoagulant Agents September 10, 2019

Posted by Andy Jagoda, MD in : Feature Update , 1 comment so far

Direct oral anticoagulant (DOAC) agents have become commonly used over the last 9 years for treatment and prophylaxis for thromboembolic conditions, following approvals by the United States Food and Drug Administration.

These anticoagulant agents, which include a direct thrombin inhibitor and factor Xa inhibitors, offer potential advantages for patients over warfarin; however, bleeding emergencies with DOACs can present diagnostic and therapeutic challenges because, unlike traditional anticoagulants, their therapeutic effect cannot be easily monitored directly with common clotting assays.

This clinical pathway will help you improve care in the management of hemorrhage in patients taking direct oral anticoagulant agents. Download now.

Clinical Pathway for Management of Hemorrhage in Patients Taking Direct Oral Anticoagulant Agents

Get access to more pathways with an individual or group subscription. Visit www.ebmedicine.net/EMPinfo to find out more!

Need more information?
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Test Your Knowledge: Concussion in the ED September 10, 2019

Posted by Andy Jagoda, MD in : Brain Tease , add a comment

An increasing number of patients with concussive injuries are presenting to the ED, due to a combination of factors, including media attention to sport-related concussion, early dedication to competitive sport, and improved screening and diagnostic tools for concussion.

Emergency clinicians play an important role in diagnosing concussion, initiating treatment, and providing concussion education to patients and their caregivers to optimize recovery.

Can you get it right?


Did you get it right? Click here to find out!

The correct answer: D.

Check out the issue on Concussion in the Emergency Department: A Review of Current Guidelines to brush up on the subject. Plus earn CME for this topic by purchasing this issue.

Clinical Flowchart for the Diagnosis of Appendicitis in Pediatric Patients September 10, 2019

Posted by Andy Jagoda, MD in : Feature Update , add a comment

Appendicitis is the most common condition in children requiring emergency abdominal surgery. Delayed or missed diagnosis in young children is common and is associated with increased rates of perforation. Although several scoring systems have been developed, there is still no consensus on clinical, laboratory, and imaging criteria for diagnosing appendicitis.

The dangers associated with misdiagnosis, delay, and perforation make quick and accurate diagnosis of appendicitis essential. This flowchart provides guidance for the management of children with appendicitis

Click the image to download your flowchart.

Clinical Pathway for the Diagnosis of Appendicitis in Pediatric Patients

Get access to more pathways with an individual or group subscription. Visit www.ebmedicine.net/PEMPinfo to find out more!

Need more information?
Click here to review the issue!

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Last Modified: 10-18-2019
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