PEM Source

Your source for all things Pediatric Emergency Medicine

All posts with tag: "environmental"

PEM Questions

(Click the link to comment and to vote - voting not working through email, sorry!)

You are working locum tenens in Breckenridge, Colorado, and see a 2 year old boy with irritability, vomiting, and poor appetite. He has no fever or diarrhea and no one else in his family is affected. The family landed in the Denver airport the night before and drove to Breckenridge. The patient awoke this morning with these symptoms. 

[yop_poll id="296"]

(Click the link to comment and to vote - voting not working through email, sorry!)

You are seeing an 18 month old girl with chief complaint of itchy scalp and rash at the nape of her neck just below her hairline. On examination, you note nits but do not see any live lice. The parents have not performed any treatments for lice. 

[yop_poll id="269"]

(Click the link to comment and to vote - voting not working through email, sorry!)

A 10 year boy was out hiking with his family, several feet ahead of everyone else. He heard a rattle, felt a sharp pain in his leg, and may have seen a snake slither away into the underbrush. He is brought to the ED 40 minutes after the event. On exam, his vitals are normal, and he has a bite mark with 2 punctures on his right calf. There is no surrounding swelling or discoloration, and the compartments are soft. He complains of pain, but no paresthesias.

[yop_poll id="258"]
(Click the link to comment and to vote - voting not working through email, sorry!) An 8 year old boy caught a spider, placed it in a jar, and was showing it to his friend when he was bit on the hand. Initially he had minimal pain but now, 1 hour later, has significant hand and arm pain and he has vomited a few times. On physical exam, the wound site is a blanched rounded patch with central punctum, and palpation of extremity reveals muscle rigidity when compared to the other side. [yop_poll id="168"]
(Click the link to comment and to vote - voting not working through email, sorry!) You are seeing a 14 year old boy who hiked in the snow yesterday with inadequate warm clothes and footwear. He has developed swollen violaceous papules and nodules on the toes of both feet. He states that the areas are itchy and sometimes have a burning sensation. Which of the following courses of action would be appropriate?
  1. Advise him to avoid further cold exposure and to use appropriate protective footwear
  2. Perform gentle rewarming in 37 to 39 degree Celsius water
  3. Perform a COVID-19 test
  4. Reassure him that this is a benign Raynaud phenomenon
[yop_poll id="153"]
(Click the link to comment and to vote - voting not working through email, sorry!) Regarding common Christmas holiday plants: [yop_poll id="78"]
(Click the link to comment and to vote - voting not working through email, sorry!) A toddler is accidentally left in the car during summer. Luckily, a bystander sees her and calls 911. The car is broken into, and the patient is brought to the PED. She has a temperature of 105.9. [yop_poll id="58"]
(Click the link to comment and to vote - voting not working through email, sorry!) A 3 year old child sustains a cold water submersion injury. He is brought in with a core temperature of 30 degrees C, in ventricular fibrillation, and is successfully defibrillated and intubated. Rewarming is occurring by: removing wet clothes, forced air warming blanket, warmed IV fluids to 40-44C, warmed humidified oxygen at 42-46C. What rate and endpoint of rewarming is best? [yop_poll id="37"]
(Click the link to comment and to vote - voting not working through email, sorry!) A 17 year old boy was scuba diving with his father. Soon after coming to surface, he began to experience symptoms of decompression illness, including joint pains, itchiness, ataxia, paresthesias, and confusion. He has been placed on 100% oxygen by non-rebreather and an IV has been placed and the plan is to transport him to a facility with a hyperbaric chamber. [yop_poll id="30"]
(Click the link to comment and to vote - voting not working through email, sorry!) Which of the following patients that sustained electrical injury requires further observation in the ED or admission (should not be discharged home now)? A) A toddler that bit on an electrical cord, has an oral commissure burn, but has normal labs and ECG and is tolerating po’s and has no active bleeding B) A 4 year old that put a fork into a European socket and sustained a small burn to the hand, is asymptomatic, has normal CK and ECG and soft compartments C) A teen who was running from law enforcement and was brought in with a retained taser dart, which has been subsequently removed, and who is currently asymptomatic D) A teen who touched a downed power line and sustained electrical shock, labs and ECG are normal and is currently asymptomatic [yop_poll id="26"]
A family obtained tuna from the local farmer’s market and prepared it for dinner. The children thought the fish tasted weird, peppery or metallic, but the parents did not, and told the children to stop complaining and eat dinner. Within 20 minutes of consumption, the children complain of headache, dizziness, pruritis, abdominal cramping, and nausea. They appear somewhat flushed in the face, neck, and chest. (Click the link to comment and to vote - voting not working through email, sorry!) [yop_poll id="12"]
Jellyfish en.wikipedia.org (Click the link to comment and to vote - voting not working through email, sorry!) [yop_poll id="10"]
A 10yo girl comes home from a family vacation to Florida in June, where she swam in the ocean. She has an itchy rash in the area covered by her bathing suit that started soon after swimming in the ocean and is still present 3 days later. Seabathers   http://www.medicinenet.com (Click the link to comment and to vote - voting not working through email, sorry!) [yop_poll id="6"]
A 16yo boy just returned from a vacation to the U.S. Virgin Islands. On the flight, he developed abdominal pain, nausea, vomiting, which he initially attributed to airsickness. He came straight from the airport to the ED, and now he also complains of lingual and circumoral paresthesias, painful paresthesias of his hands and feet, feeling as though his teeth feel “loose”, and generalized weakness. Another classic symptom of this entity is: A. Urticaria and flushing B. Tachycardia C. Profuse watery diarrhea D. Paralysis E. Temperature reversal Also, if you’re interested in the Peds ID Antibiotics Question of the Week, you can find it here

Controversies

(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"]

Oops! We detected that you are on mobile and in portrait mode.


Please turn your phone to landscape mode to view this website. If you are not on mobile, extend your browser window.