PEM Source

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Controversies

(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other!

You are seeing a 14 year old high school Freshman brought in for minor cold symptoms consisting of sporadic dry cough and nasal congestion. There is no fever, and the patient is negative for COVID, RSV, and influenza. The patient is well appearing and spends the majority of the visit on her mobile phone. The parent asks for a school note. What duration of time off from school do you typically give on the school note?

[poll id="74"]

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Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

The AAP Otitis Media (OM) guidelines note that the majority of OM spontaneously resolves, with a number needed to treat (NNT) with antibiotics of 15-20 in low risk cases. Clinicians and parents can elect an "observation option" in select patients that are nontoxic, have temperature < 39 C, have had ear pain for < 48 hours, and have mild ear pain, and have no otorrhea; this applies to children aged 6-23 months with unilateral OM, and children > 24 months with bilateral OM. If symptoms persist for 48-72 hours, then antibiotics should be started.

[poll id="73"]

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Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

If due to a combination of low rates due to public health measures, low risk due to vaccinations and treatments available, COVID is under control and poses no additional morbidity or mortality risk to you, your family, or your patients, and your hospital no longer requires masks for patients or physicians, would you still wear a mask for your PED shifts?

[poll id="72"]

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Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

[poll id="70"]

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Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

You are seeing a child who has been passing infrequent stools, and when the child does stool, the stools are hard.

[poll id="69"]

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Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

How should ED's handle patients with mild URI symptoms who mostly want a COVID test?

[poll id="68"]

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Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

[poll id="67"]

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Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

[poll id="66"]

(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other!

You are seeing a 30 day old full term infant whose parents thought the baby felt warm, checked the temperature with an infrared mid-forehead thermometer, and it read 100.4. They did not give any antipyretics and came straight to the ED. The rectal temperature in the ED is 99. Mother received prenatal care, there were no complications, and she was GBS negative. There are no ill contacts and the baby is well-appearing and feeding normally.

[poll id="65"]

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Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

You're seeing a child with CT-confirmed uncomplicated appendicitis. The child has had symptoms for 12 hours, and pain is well controlled with medications. You've given IV antibiotics. You're informed by utilization review that the child is not approved to stay at your hospital and must be transferred according to the insurance plan; the transfer will take 4-8 hours to coordinate.

[poll id="64"]

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Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

The new AAP Subcommittee on the Febrile Infant guidelines for managing febrile 8-60 day olds gives the option to perform an LP for febrile 22-28 day olds only if inflammatory markers, if obtained, are abnormal (Temp > 38.5, Procalcitonin > 0.5 ng/mL, CRP > 20 mg/dL, ANC > 4500-5200). This is an option even for the infant with a + UA. If an LP is not performed, they do recommend admission to the hospital and treatment with parenteral antibiotics. This is a change from prior practice, where concerns about masking meningitis obviated administration of parenteral antibiotics without performing the LP. What are your thoughts?

[poll id="63"]

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Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

You are seeing a child who has had a self-resolving 5 minute generalized tonic-clonic seizure for the first time. The patient is afebrile, previously healthy, and has a normal non-focal neurologic exam. There is no evidence on your evaluation of another cause for the seizure, such as meningitis or a toxicological cause. There is no associated headache or vomiting. Family history if non-contributory. MRI is unavailable from the ED.

[poll id="62"]

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Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

[poll id="61"]

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Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

[poll id="60"]

(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other!

[poll id="59"]

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Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

[poll id="58"]

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A full term infant born out of asepsis (BOA) at home is brought in by ambulance to your PED. No neonatologist or pediatrician is in house. The baby's venous blood gas shows a pH of 6.9, PCO2 80. The baby has inadequate respirations. Which do you decide to do?

[poll id="57"]

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Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

You have diagnosed an 11 year old boy who has a PMH of mild intermittent asthma with COVID (he has been symptomatic with fever, vomiting, cough, and myalgias for 2 days). Currently, his RR is 20, SaO2 98% on room air, and his lungs are clear to auscultation. He has home albuterol MDI with spacer available. You discharge him with a portable pulse oximeter. For what persistent SaO2 would you tell the parent to bring him back to the ED?

[poll id="56"]

(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other!

[poll id="55"]

(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! A 17mo old is brought in for rhinorrhea and mild cough. The patient is well-appearing, has no past medical history, is not on any medications, and is up to date on immunizations. Physical examination is normal. Vital signs are: temperature 35.8 rectal, heart rate 100, respiratory rate 24, blood pressure 85/42, pulse ox 100% on room air. The child is wearing a standard hospital gown and was brought in wearing appropriate clothing for the ambient mild outdoor weather. What would you do given the hypothermic rectal temperature? [poll id="54"]  
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! A recent randomized controlled trial by the CODA collaborative found a 10-day course of antibiotics to be non-inferior to appendectomy in adult, with 30-day health status as the primary outcome. By 90 days of follow-up, 29% of the antibiotics group had undergone appendectomy. Complications were more common in the antibiotics group, but not in the subgroup with no appendicolith. If you were seeing a young healthy male with acute appendicitis of short duration, afebrile, normal labs, no appendicolith, mild pain, tolerating oral intake, would you consider treating with antibiotics only? [poll id="53"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! [poll id="52"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! You are seeing a 9 year old with a knee laceration IMG_1416 [poll id="51"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! Your emergency medicine colleague has a 7mo old, immunized, well-appearing, no PMH, with a fever of 40 C and no other symptoms. They have been scrupulously self-isolating, wiping down packages, etc. Your colleague has adhered to maximal PPE use including using N95s usually at work. No one around the child has been symptomatic. Your colleague asks what work-up you suggest in this era of COVID. [poll id="50"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! You are seeing a 3yo child whose parents are essential workers and have recently tested positive for COVID-19. The child has had 3 days of fever, vomiting and diarrhea a few times per day with intermittent mild abdominal pain, and has a nonspecific blanching macular rash on the trunk and somewhat on the extremities. The child is well-appearing with good perfusion and hemodynamically stable, but is febrile in the ED. There are no respiratory symptoms, distress, nor hypoxia. [poll id="49"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! [poll id="48"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! With the COVID-19 pandemic, PED volumes are low nationwide. A recent SAEM COVID-19 national grand rounds webinar suggested that PED's, to help out inundated adult ED's, might see adult patients up to age 35 years. I tried to pick the most common ages, but feel free to comment with specifics! [poll id="47"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! Couldn't put every possibility, so pick the one closest to what you are doing. Also, your choice may depend on your hospital's recommendations and your PPE availability [poll id="46"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! Parents bring a 15mo old non-black uncircumcised well-appearing fully immunized male with 3 hours of fever and no other symptoms. His temperature is 39 C. You find no clear source for the fever on exam. It is wintertime and his siblings all have URIs but this patient has no cough or congestion. He has not had any prior UTIs. Do you catheterize him for urine to rule out UTI? [poll id="45"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! Reviving an old one since it's pretty relevant again. Added some commentary in the Comments section. [poll id="19"]
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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! [poll id="44"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! [poll id="43"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! A 7 year old boy presents after injuring his lateral soft palate with a straw. He is completely asymptomatic and exam other than what is shown is normal. Palate injury [poll id="42"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! [poll id="41"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! Bilimeters are devices that measure bilirubin transcutaneously (ie without drawing blood). They work by directing light into the neonate's skin and then measuring the intensity of specific wavelengths that return, and using this information to calculate bilirubin level. [poll id="40"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! [poll id="39"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! You are seeing a 15 month old brought in for simple febrile seizure lasting 2 minutes. The child is back to baseline and well appearing. The vital signs are temperature 40.4 C, HR 175, RR 30, BP 80/40. Exam reveals no source for infection. The child has no vaccinations at all by parent choice. [poll id="38"]  
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! [poll id="37"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! [poll id="36"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! You are seeing a 4 year old child in significant distress due to a headache, which he has had for 2 days. It is bilateral, frontotemporal, not sudden onset, never had before. No associated fever, vomiting, neurologic abnormalities, relevant past medical history. Do you image? [poll id="35"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! [poll id="34"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! You are seeing a 29 day old afebrile former 35 weeker brought in by ambulance. The patient was given a few sips of "gripe water" for runny nose, appeared to choke and gasp for air, turned blue briefly, then recovered. The entire episode was about a minute. There was no tone change. The baby has no birth complications. The baby's vital signs and physical exam are normal in the ED, pulse ox is 100% on room air, RSV testing is negative. What would be your management? [poll id="33"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! You are seeing a 14 month old whose parents have chosen not to vaccinate him. He has a fever of 39.2 for one day and no other symptoms. He is circumcised. He appears well and has no known ill contacts. His physical examination is unremarkable. [poll id="32"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! It's the day after Thanksgiving, and your patient just ate a bunch of leftovers before getting into an automobile accident. You are intubating, and hoping the patient doesn't aspirate during the procedure. A medical student asks whether he should apply cricoid pressure for you. [poll id="31"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! You are seeing a 19 year old with a history of illicit drug use brought in with sudden onset cardiac arrest. He received bystander CPR immediately after the arrest, and is in a ventricular fibrillation rhythm that has persisted despite 5 shocks, epinephrine, and amiodarone following the ACLS algorithm. [poll id="30"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! You are seeing a 3 year old with 2nd lifetime episode of SVT. The patient has no other prior PMH, was not on any medications, was healthy prior, and does not have WPW. After 2 doses of properly administered adenosine, the patient is still in SVT. She is alert, not toxic, has good perfusion, and is not hypotensive. [poll id="29"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! You are seeing a 4 year old in status epilepticus. The patient is not on anti-epileptics at home. The patient has received benzodiazepines x 3 and fosphenytoin 20 mg/kg. Glucose and electrolytes are normal. The patient is afebrile. [poll id="28"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! You are seeing a patient with a simple small abscess and no or minimal overlying cellulitis, nontoxic and afebrile, immunizations up to date, no prior abscesses. After successful incision and drainage, what treatment would you give? [poll id="27"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! An 8yo patient with history of mild intermittent asthma comes in with an acute exacerbation that clears readily with 1 treatment of nebulized albuterol. The patient has had 2 similar ED visits in the last 3 months. The patient has an albuterol MDI for home use, but no spacer. The patient is not on any controller medications. The respiratory therapist has taught the patient/parents how to use the MDI properly with a spacer, and you are discharging the patient home. [poll id="26"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! You are seeing a 4 year old with 1 day of limp and now, refusal to bear weight. He is afebrile. On exam, his hip is irritable to passive external and internal rotation. He holds his hip slightly externally rotated. His CBC WBC is 8,400 with 50% neutrophils, and his ESR is 20. His plain films are normal. He has reliable parents and an assigned pediatrician who can see him the next day. [poll id="25"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! [poll id="24"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! For pediatric blunt trauma patients... [poll id="23"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! A repeat - since we are in the throes of influenza season right now, and this is a particularly controversial issue. Many emergency medicine FOAM bloggers have argued against the use of oseltamivir, such as here. But, the CDC continues to recommend it for high risk patients presenting with < 48 hours of symptoms, citing their reasoning here. To complicate things further, the "definition" of influenza-like illness basically includes nearly all kids seen in the ED in the wintertime - fever and cough or sore throat, and point-of-care tests are not very sensitive. [poll id="19"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! Got this one from a recent EM physician facebook group post. You see a mother with symptoms of influenza. Her 3 day old asymptomatic full-term infant is tested and is POC influenza+. There is good follow-up and the patient is healthy, afebrile, feeding well, etc. [poll id="22"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! You are seeing a 10 week old infant with a 38 degree fever of 6 hours duration. He has mild rhinorrhea as does Dad. He is otherwise well and feeding well. Point of care RSV and influenza are negative, and urine shows no pyuria or bacteriuria. Review of the chart shows mom was GBS+ and was treated with intrapartum penicillin as recommended. Baby was observed for 2 days in the nursery but not treated with antibiotics. [poll id="21"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! [poll id="20"]
(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 regarding your thought processes and the evidence behind your decisions. We can learn from each other! [poll id="19"]
A 2 month old was seen in the ED 36 hours ago with a temperature of 39.2. The CBC had a WBC of 11.2 with 70% lymphocytes and no bandemia. Urinalysis was negative. The lab calls you to report that 1 of 2 blood culture bottles is growing gram positive cocci in clusters. You call the patient and the parent reports that he is doing well, is now thought to be afebrile (tactile, parents have not checked the temperature in 24 hours), and is feeding well. What do you do? (Click the link to comment and to vote - voting not working through email, sorry!) [poll id="18"]
You are about to incise and drain a relatively small simple abscess in a healthy child. (Click the link to comment and to vote - voting not working through email, sorry!) [poll id="17"]
Do you do a CT and LP on all complex febrile seizure patients? [poll id="16"]
What do you include in your GI cocktail for adolescents? [poll id="15"]
You are seeing a 4 year old with a deep cheek laceration with irregular margins, under some tension. The parents express concerns about scarring, and they are also concerned that their child will definitely not be able to stay still for repair or for suture removal. Plastic surgery is unavailable, and the parents are amenable to having you repair the laceration with procedural sedation. Forheadlac (Source: Closing the Gap https://lacerationrepair.com) [poll id="14"]
You are seeing a 5 year old with intermittent LLQ abdominal pain for a month. She is well appearing and has a benign abdominal exam. She is eating normally, not vomiting, and has no fever or diarrhea. The parents deny constipation or hard stools, but you suspect constipation is the diagnosis. [poll id="13"]
You are seeing a 6 week old ex-full term infant who is breastfeeding exclusively, having 6 wet diapers per day, 4 or more soft seedy stools per day, growing well, and no fever. Baby has been jaundiced since 1st week of life, and while it is not worse, parents come in because it is prolonged. Jaundice is to the level of the chest, and transcutaneous bili is 10. [poll id="12"]
It's RSV season and you're seeing a 30 day old ex-39 week infant with a runny nose. The resident has ordered a POC RSV, which is positive. The baby is afebrile, feeding well, and nontoxic. Do you admit the infant just for being RSV positive due to the risk of apnea in this age group? [poll id="11"]
You are seeing a 6 year old with a wet-sounding cough for 4 days and fever to 39 C for 3 days. You hear crackles in the right lower lobe; there is no wheezing. CXR shows no infiltrates. Do you diagnose a "clinical pneumonia" with false negative CXR and treat with antibiotics? [poll id="10"]
Vote! But for something other than President... You are seeing a 3mo old with clinical bronchiolitis who is otherwise well-appearing, tolerating po's, not in significant respiratory distress, afebrile, has good follow-up. At what O2 sat do you admit the patient for supplementary O2? The AAP says: aap-bronchiolitis-o2-sat [poll id="9"]
3 week old infant is brought in with fever of 38.5. The baby is well appearing and does not have any high risk factors in the birth history. You plan to get urine, blood, and CSF cultures and give empiric IV antibiotics. [poll id="8"]
You are seeing a 35 month old boy with fever and sore throat x 2 days. He has no cough or runny nose, but his sister also had fever and sore throat recently, and his mom has a cough. His temp is 38.5. He has no tonsillar exudate or palatal petechiae, and only tender cervical lymphadenopathy. He is otherwise well appearing, previously healthy, and is well hydrated. [poll id="6"]
Nearly 3 year old girl was eating nuts and had a coughing episode. 6 year old sibling told parents "she's choking on the nuts." In the ED, patient is completely asymptomatic, has a normal CXR and a 100% O2 sat on room air. [poll id="7"]
You are seeing a 15 month old female with 36 hours of fever, current temp in ED 38.9 rectal (last antipyretic 6 hours prior), no other symptoms, well-appearing, no past medical history. Which would you do? [poll id="5"]
How much work-up do you do in the well-appearing, term, feeding, 29-60 day old infant with low-grade fever (38-38.5) without source? What about the 61-89 day old? [poll id="2"]
You're seeing a febrile well-appearing 29-60 day old with clear lab evidence of UTI and benign CBC. Do you do an LP? Do you admit and do you give parenteral antibiotics? What about for a 61-90 day old?
When was the last time you saw a kid have a paradoxical reaction to a benzo and how did you treat it? a. Wait it out b. More benzos c. Flumazenil d. Haldol e. Something else???  Have heard precedex, ketamine, propofol all suggested. Click post to read and add comments
You're seeing a 10yo who weighs 40 kg for acute asthma exacerbation. Do you give decadron or prednisone? If you give decadron, do you give 0.6 mg/kg or a lower dose? What is your maximum dose of decadron for asthma? Click post to read and add comments [poll id="4"]

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