MIS-C in the Mix: New Algorithm Factors in COVID-19 for Kids with Fever + Rash
June 18, 2020


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

As time passes, we are learning more about COVID-19 and how it presents in children. As most PEM providers now know, Multisystem Inflammatory Syndrome in Children, or MIS-C is a hyperinflammatory state likely related to previous exposure to the SARS-CoV-2 virus. There is a spectrum of presentations of MIS-C, but current case definitions include fever and involvement of 2 or more organ systems. One of the organ systems that can be involved is skin.  read more

Stories From the Front Lines: Emergency Medicine Staff and the Fight Against COVID-19
May 6, 2020


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Stories From the Front Lines: Emergency Medicine Staff and the Fight Against COVID-19

Every night at 7 p.m., the streets of New York City, once cluttered with the noise of honking taxi cabs, buzzing crowds, and screeching trains, are now filled with a different sound—the sound of rhythmic chants and gracious applause. read more

Palliative Care in COVID-19
April 23, 2020


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

Palliative Care Principles in the Age of COVID-19

By Ashley Shreves, MD

Most emergency clinicians are familiar with the guiding principles of palliative care, which focus on improving the quality of life for patients who are facing life-threatening illnesses. Palliative care uses a variety of mechanisms to ensure that patient values and goals are aligned with the medical treatment being given, while careful attention is paid to the patient’s pain and to the physical, psychosocial, and spiritual symptoms of the illness. I have been working in New Orleans as an emergency medicine and palliative care physician throughout the COVID-19 pandemic (except for the week that I had COVID-19 myself) and can share my observations about how palliative care principles apply to this patient population. read more

Risk Management Pitfalls for Management of Pediatric Patients With Tick-Borne Illnesses
April 16, 2020


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Tick-borne illnesses are increasing in prevalence and geographic reach. Because the presentation of these illnesses is sometimes nonspecific, they can often be misdiagnosed, especially in the early stages of illness. A detailed history with questions involving recent activities and travel and a thorough physical examination will help narrow the diagnosis. While some illnesses can be diagnosed on clinical findings alone, others require confirmatory testing, which may take days to weeks to result. read more

Risk Management Pitfalls in the Management of Pediatric Patients With Bacterial Meningitis
March 19, 2020


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The presentation of bacterial meningitis can overlap with viral meningitis and other conditions, and emergency clinicians must remain vigilant to avoid delaying treatment for a child with bacterial meningitis. Inflammatory markers, such as procalcitonin, in the serum and cerebrospinal fluid may help distinguish between bacterial meningitis and viral meningitis. Appropriate early antibiotic treatment and management for bacterial meningitis is critical for optimal outcomes. Although debated, corticosteroids should be considered in certain cases. read more

A Systematic Approach Diabetic Hyperglycemic Emergencies
March 17, 2020


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

Midway through your shift, a 30-year-old man presents in DKA. He is a known type 1 diabetic patient and has an insulin pump that he says has been alarming. He is awake, alert, and his vital signs at triage are as follows: blood pressure, 110/60 mm Hg; heart rate, 121 beats/min; respiratory rate, 26 breaths/min, temperature, 35.6°C (96°F); and oxygen saturation, 100% on room air. His fingerstick glucose level is high, and his venous pH is 7.12. read more

Clinical Pathway For Management of Pediatric Patients With Potential Complications of Eating Disorders
February 17, 2020


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

Patients with undiagnosed eating disorders can present with complaints that are common to the emergency department (ED), such as abdominal pain, chest pain, syncope, and/or palpitations. This can make it difficult for the emergency clinician to recognize that these complaints arise from an underlying eating disorder. read more

What’s Your Diagnosis? A 14-year-old girl with no known medical problems
February 2, 2020


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

But before we begin, check out if you got last month’s case right, about a 1-year-old boy with rhinorrhea, congestion, cough, and fever. Click here to check out the answer!

Case Presentation: a 14-year-old girl with no known medical problems

A 14-year-old girl with no known medical problems presents to the ED with worsening epigastric pain for 3 days. The girl says the pain worsens after eating. The patient denies associated symptoms including vomiting, diarrhea, constipation, dysuria, and fever. The patient also denies alcohol consumption, drug use, and sexual activity. read more

What’s Your Diagnosis? Ill-appearing and Tachypneic 23-year-old
January 31, 2020


Posted by Andy Jagoda, MD in: Feature Update , 3 comments

Case Presentation: Ill-appearing and Tachypneic 23-year-old Midway through your shift, a 23-year-old woman arrives by EMS. She is ill-appearing, tachypneic, and has a distinct odor you recognize as ketones. Her bedside glucose is 680 mg/dL. You suspect DKA, but wonder what led to it.

How to unlock 40% more LLSA options
January 29, 2020


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

You just finished a rewarding but intensely grueling day.

Caseloads were high, patients were demanding, and time to JUST BREATHE was scarce.

You give your inbox a quick glance before going home to get some sleep so you can do it all again tomorrow, and one email yells for your attention: “REMINDER! LLSA requirement for your ABEM certification.” Yikes. Just what you need… one more thing on your plate. You buckle down to fork out $$ and precious time to meet your ABEM certification requirement.

Unlock more LLSA options read more