What’s Your Diagnosis? Seizures in Neonates: Diagnosis and Management in the Emergency Department
May 29, 2020


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Case Presentation: Seizures in Neonates: Diagnosis and Management in the Emergency Department

An EMS team brings in a 5-day-old boy with a history of a rhythmic, left-arm-shaking episode at home. The parents tell you the pregnancy was normal and the birth was a full-term, normal spontaneous vaginal delivery. The baby had been doing well until yesterday, when he started eating less and not waking up for feeds. The baby has low tone with a tense anterior fontanelle, and his temperature is 35.8˚C (96.4˚F). What workup is warranted at this time? 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

Test Your Knowledge: Synthetic Drug Intoxication in Children
February 21, 2020


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Pediatric Emergency Medicine Practice Blog Brain Teaser

The continually changing chemical formulations of synthetic drugs makes recognition and diagnosis of intoxication from these substances challenging. When children and adolescents present to the emergency department with agitation or mental status changes, intoxication from synthetic drug use should be in the differential diagnosis. Identifying the responsible compound(s) may be difficult, so asking the patient broad questions and utilizing appropriate diagnostic studies, when indicated, will aid in making the diagnosis and help identify more-serious complications. read more

Clinical Pathway for Emergency Department Management of Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State
February 18, 2020


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Click to review the Clinical Pathway for Emergency Department Management of Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State

Hyperglycemic emergencies – diabetic ketoacidosis (DKA) and the hyperosmolar hyperglycemic state (HHS) – are common presentations in the ED that require swift, specialized management strategies. Uncovering the precipitating event is critical to management, as morbidity and mortality are related more to the trigger than the DKA/HHS itself. read more

Test Your Knowledge: Evaluation and Management of Life-Threatening Headaches in the ED
February 6, 2020


Posted by Andy Jagoda, MD in: Brain Tease , 1 comment so far

Emergency Medicine Practice Blog Brain Teaser

Though patients often present to the ED seeking relief from headaches that cause significant pain and suffering, 90% of them can be considered “benign.” It is essential to identify the 10% of headache patients who are in danger of having a life-threatening disorder presenting with a sudden and severe headache to ensure that they are treated quickly and effectively. read more

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

Risk Management Pitfalls in the Management of Pediatric Stroke
January 21, 2020


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

Stroke is a leading cause of morbidity and mortality in children. The etiologies, risk factors, and presentation of stroke differ from those of adults, and the diagnosis of stroke is often delayed in children. The management of pediatric stroke can be challenging because there are few data to support the efficacy of interventions. read more

Test Your Knowledge: Rash and Fever in the Pediatric Patient
January 21, 2020


Posted by Andy Jagoda, MD in: Brain Tease , 1 comment so far

Rash and fever are some of the most common chief complaints presenting in emergency medicine. The evaluation of skin rashes in the febrile pediatric patient includes a broad differential diagnosis and utilizing the signs and symptoms to identify red flags, such as hemodynamic instability, erythroderma, desquamation, petechiae/purpura, mucous membrane involvement, and severe pain, in the history and physical examination that require a high index of suspicion for worrisome disease.

Test your knowledge of characteristics of common rashes in a pediatric patients!

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Review this Pediatric Emergency Medicine Practice issue to get up-to-date on common and life-threatening skin rashes with fever in children, guidance for differentiating the types of infections based on signs and symptoms, indications for diagnostic studies, and recommendations for treatment of pediatric skin rash with fever in the emergency department.

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What’s Your Diagnosis? A 1-year-old Boy With Rhinorrhea
January 3, 2020


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But before we begin, check out if you got last month’s case right, about a 4-year-old with fever, right leg pain, and difficulty walking. Click here to check out the answer! read more