Case Scenario: Another “fever, rash” pop ups on the board during a busy Peds ED shift. At first glance, you realize this patient is very sick. She is an 8 yo female with rash, lethargy, fever > 104F for four days. The pt is lethargic, tachycardic, tachypneic with rash including the palms. She has meningeal signs, lactic acid is 7. DDx is broad. LP is performed, you resuscitate, give broad spectrum Abx. Patient is admitted and ultimately diagnosed with atypical Kawasaki Disease. After IVIG is given, the patient becomes less fussy but BL lower extremity weakness develops. Hypotonia is appreciated in her legs. Uh oh!
You are following up on the chart two days later and wondering, “What the heck is going on?! Is this a complication of the LP procedure??” Not to worry. An MRI of the spine is obtained. MRI reveals infectious or inflammatory transverse myelitis. The patient is given a burst of IV steroids and all neurologic symptoms resolve.
Disclaimer: Cases do not reflect specific patient encounters by faculty, rather, they are made up by Faculty for educational purposes.
We recently had a lively discussion on the merits of Ketamine for analgesia in an ED setting at our Wake Forest EM resident conference. Click through for the details and some tips on ketamine use for pain. Continue reading Ketamine Analgesia in the ED
Congratulations…you made it! You’re a “real doctor” now. Everything for which you have worked so hard has finally paid off and your career in Emergency Medicine is officially launching. Internship is an exciting (and challenging) starting point in that launch sequence. A smooth and successful internship can set a positive tone for your residency experience and help establish the foundation for a successful and satisfying career.
Now that you are settled into to your new home, figured out where to park at the hospital and know how to get to the restroom (ah, the mundane but crucial details!), here are a few things to keep in mind during your first 30 days of intern year.
Continue reading EM Intern Road Map – the first 30 days
Few tasks are more challenging than getting a reliable abdominal exam on an upset child. Over the years I have developed a strategy that has increased my success rate exponentially and it can be distilled down to a few key factors.
Continue reading The Angry Toddler Whisperer
In this month’s issue of Emergency Physician Monthly Dr. Cedric Lefebvre reviews ACEP Clinical Policy: Aortic Dissection for the evaluation of potential aortic dissection. It has always been difficult to make the diagnosis of aortic dissection as the condition is rare and the presenting symptoms can be quite variable. Dr. Lefebvre does an admirable job of pointing out potential pitfalls in the guidelines and limitations of the current diagnostic options. Check it out!
Faculty member Dr. Lane Smith’s comments on his paper that was published in the Journal of Trauma and Acute Care Surgery, titled, “SIRT1 mediates a primed response to immune challenge after traumatic lung injury:”
Continue reading Pulmonary Contusion and the Hyperimmune Response