Glasgow coma scale is the standard used in assessing and documenting level of consciousness in head trauma. The AVPU (Alert, responsive to Verbal stimuli, responsive to Pain, Unresponsive) scale is a quicker assessment also commonly documented and used. It can… Continue Reading →
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(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing an adolescent who had a syncopal episode at school. It occurred 10 minutes after P.E. class had finished, when she was in… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing an 18-month-old brought in by ambulance for simple febrile seizure that lasted 2 minutes. You have determined the source of his fever… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 3 year old child with 3 weeks of gradually progressing low back pain, now impacting her ability or willingness to walk…. Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are evaluating a 15 year old girl brought in from a foster home for symptoms of psychosis.
(Click the link to comment and to vote – voting not working through email, sorry!) Which of the following physical exam findings on a newborn’s sacrum does NOT mandate an MRI to rule out occult closed spinal dysraphism?
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 12 year old child that presents with altered mental status, fever, and history of headache and vomiting before the decline in… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing an 8 year old boy brought in by ambulance for a first time unprovoked afebrile seizure. The seizure was generalized tonic-clonic and… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A 10 day old presents with shaking of bilateral upper extremities and jitteriness. The patient was a term infant born NSVD with no complications. He… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 9 year old boy who returned from a camping trip in Colorado 6 days ago. He had some vague complaints of… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 3 year old ex-premature infant who has a ventriculoperitoneal shunt in place. The patient presents with fever to 38.3, cough, and… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →
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(Click the link to comment and to vote – voting not working through email, sorry!) Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry! You are seeing a 3 year old child with unrepaired Tetralogy of Fallot who presented with a generalized tonic-clonic seizure, and residual hemiparesis and speech… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) EMS is bringing you a 10yo patient that has been actively seizing for 20 minutes. They are unable to obtain IV access.
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PEM Infographics (linked here) has many helpful infographics. One of my all-time favorites is how to use rock-paper-scissors-OK sign to test children’s peripheral nerves in the upper extremity / hand exam
Click the link to comment and to vote – voting not working through email, sorry!) Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) EMS has brought in an 8 month old child who had a generalized tonic-clonic seizure at home. The child has a history of 2 prior… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 6 year old boy with a few days of episodes of crying and jaw clenching, decreased oral intake, and intermittent painful… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 15 month old who became angry about a toy being taken away, cried, turned blue in the face, passed out, and… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 1yo child in status epilepticus (first time seizure). The child received 0.2 mg/kg intranasal midazolam in the field, 0.1 mg/kg IV… Continue Reading →
Success rates in infant lumbar punctures may be declining as we do fewer and fewer (doing fewer is a good thing, except that we get less experience). One thing that can improve success is early stylet removal. The stylet is… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A 12 year old boy with a history of ADHD on Adderall comes in for acute onset weakness of his bilateral upper arms, particularly on… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A 2 year old child has a flat lesion of the entire left forehead and upper eyelid the color of light red wine that has… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A 4 year old with ventriculoperitoneal shunt revision 1 month ago, presents with headache and vomiting and increased sleepiness according to mom. The patient is… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A 14 month old is brought in with lethargy and obtundation. The patient is breathing spontaneously and has stable vital signs. The parents admit that… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 5 year old fully immunized patient with 2 weeks of new onset bedwetting, 3 days of cough and fever, and 2… Continue Reading →
Do you do a CT and LP on all complex febrile seizure patients?
A 19yo man presents with progressively worsening extremity numbness in a glove and stocking distribution and ataxia x 1 month. He has areflexia, weakness, and a wide-based gait on exam. (Click the link to comment and to vote – voting… Continue Reading →
Mucosal atomizer devices improve administration of intranasal medications. Intranasal fentanyl 1.5 mcg/kg is a great way to give stronger pain medication (eg for fractures) without placing an IV. Intranasal midazolam 0.2 mg/kg (use concentrated 5mg/mL form to keep total volume… Continue Reading →
A 10yo was a rear seat passenger in a high-speed MVA, belted only with a lapbelt, and had a hyperflexion injury mechanism during impact. The patient cannot move his legs, and does not have lower extremity sensation to light touch… Continue Reading →
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