What organisms do Cephalosporins not cover? Remember LAME: Listeria, Atypicals, MRSA, and Enterococci
(Click the link to comment and to vote – voting not working through email, sorry!) A previously-healthy 12-year old girl who was allowed to get a high cartilage ear piercing after much begging now comes in with evidence of infection… Continue Reading →
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(Click the link to comment and to vote – voting not working through email, sorry!) Parents bring in their 11 month old baby for a new-onset rash. The baby is unimmunized by parent choice. The baby had fever for the… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 3 year old boy with unresolving right-sided ear infection. He was first seen 1 month ago and diagnosed with right AOM… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!)A You are seeing a 3-year-old boy with 2 days of fever to a maximum of 102.7 F, an urticarial rash (but no enanthem), and significant… Continue Reading →
Picture this: you’re seeing a 3 year old girl with fever for 4 days, cough and runny nose (her parents estimate that since starting preschool she has had cough and runny nose 75% of the time). She has no evidence… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 17 year old girl that works in a pet store, where she is sometimes scratched by the animals there. She felt… 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 seeing an 8 year old girl with fever of unclear etiology for 7 days. She is well appearing. Exam reveals 1-2cm tender nodes… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are evaluating a 10 year old patient who had a bone marrow transplant 2 months ago. The patient is presenting with low-grade fever, a… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) During the recent “tri-demic” of influenza, RSV, and COVID disease, there was also a nationwide shortage of common oral liquid antibiotics used to treat otitis… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) COVID is on the rise again, with a more transmissible and immune-evading variant. Nirmatrelvir-ritonavir (brand name Paxlovid) is approved for children 12 years and older… Continue Reading →
The use and interpretation of rapid COVID-19 tests to reduce transmission is changing slightly with new variants and increased natural and vaccine-induced immunity in the population. A positive rapid test (even a very faint line) remains a good indicator of… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) We are currently experiencing a “tridemic” of influenza, RSV, and COVID-19.
We are seeing unprecedented numbers of cases of RSV, and many of our patients are older school-age children. Ever wonder when those kids can return to school? RSV is contagious up to 8 days after symptom onset, so children can… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing an 8 year old male with 3 days of progressively worsening redness, tenderness, and swelling of his right index finger proximal lateral… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) It’s summertime, and you are seeing a 15 month old with fever and papulovesicular lesions on the palms, lateral borders of the feet and soles,… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A 17yo boy presents with fever, myalgias, headaches, swollen cervical lymph nodes, and a maculopapular rash that became vesiculopustular on his face, torso, and extremities… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing an 8 year old girl who was prescribed an oral cephalosporin antibiotic 1 week ago for rhinitis. She has 3 more days… 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 →
(Click the link to comment and to vote – voting not working through email, sorry!) A 6 month old female infant is referred in from PMD for concerns regarding the GU exam. Physical examinations at the 2 and 4 month… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 10 month old infant with one day of fever, purpuric rash, and subcutaneous edema of bilateral extremities. He was seen in… 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 →
(Click the link to comment and to vote – voting not working through email, sorry!) A seven day old neonate is brought in for a fever of 38.5 and lethargy. The baby had a home birth, and the parents have… Continue Reading →
(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!) What are pediatric emergency physicians seeing more of when COVID prevalence rises?
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 10 day old ex-full term infant with bilateral watery mucoid eye discharge, mild eyelid edema, and papillary conjunctivitis. You suspect chlamydial… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 7 year old boy who presents with dark coca-cola colored urine and puffy eyes. You suspect glomerulonephritis. Which of the following… 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 →
While up to 10% of patients may think they have an allergy to beta-lactam antibiotics, fewer than 1% have a true IgE-mediated hypersensitivity, with concomitant risk of anaphylaxis. However, even if a true allergy is confirmed, this does not mean… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a toddler with 2 days of cough, congestion, and low-grade fever, who now presents with a worsened barky cough. His vital signs… 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 regarding… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 3 year old ill-appearing child with high fever and rash. She initially started with tender erythema in her skin folds, progressing… Continue Reading →
Parent / guardian unsure of the child’s immunization history? Almost every state has an immunization registry, and EMRs are often configured to be able to access them – ask your institution’s IT person how if that’s possible. For a quick… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 3 year old girl who was discharged from the hospital a week ago. At that time, she presented with fever, intermittent… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Your ED is providing patients who are eligible and interested in receiving the COVID-19 vaccine the opportunity to receive the 1st dose of an mRNA vaccine… Continue Reading →
You’ve probably heard… AAP Subcommittee on Febrile Infants came out with new guidelines. The algorithms have been posted on PEMsource algorithms page, and the fever table updated to reflect them. Also, the CDC came out with new guidelines regarding STI… 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 →
(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 →
Treating abscesses by making two smaller incisions and placing a loop through them is becoming popular, preferred by many over traditional I&D. For a review of the technique: https://pemcincinnati.com/blog/loop-abscess/ Don’t have a vessel loop? You can use the cuff of any glove… Continue Reading →
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Of course, we’re going to test everyone for COVID, but this handy chart from National Jewish helps differentiate the common symptoms and course of COVID-19 with those of colds, influenza, and allergies
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a previously healthy 9-month old boy brought in for rash. The child had 3 days of fever. He was seen yesterday evening… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 4 month old infant with fever, nasal congestion, and cough for 2 days. The baby is a previously well ex-full term… Continue Reading →
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A trio of recent publications on pediatric UTI offer some insights. First, Mattoo et al offer a review of UTI diagnosis and management in children. Nadeem et al studied the optimal WBC cutoffs for diagnosing UTI, balancing overdiagnosis/overtreatment with underdiagnosis/missed UTIs, based on the… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are caring for a 19 year old woman who is breastfeeding her 2 month old infant. She has a superficial 2cm breast abscess located… 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 →
(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 →
To remember the difference in antibiotic regimens for chlamydia cervicitis / urethritis vs pelvic inflammatory disease, rap this in your head: Ceph 10 x 50 for GC is nifty; give Zith 1 gram for the chlam, but doxy 14 days… 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 2 year old who is slowly improving from a bout of acute gastroenteritis manifested by fever, vomiting, diarrhea, and abdominal pain… 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 13 year old girl with 2 days of left eye redness and pain, and 1 day of fever. She recently got… Continue Reading →
(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… Continue Reading →
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(Click the link to comment and to vote – voting not working through email, sorry!) A 2yo child presents with a 1.5cm diameter erythematous tender fluctuant swelling in the right preauricular area. There is a small pinhole sized indentation in… Continue Reading →
Here’s a great way to store your N-95 for re-use, and here is a great article on N-95s and re-using them
(Click the link to comment and to vote – voting not working through email, sorry!) Match the child with acute otitis media to appropriate therapy per AAP guidelines (all children well-appearing, non-toxic, no distress or indications of severe otalgia, symptomatic… 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 recent JAMA article summarized China’s experience with 72,314 COVID-19 novel coronavirus cases (Wu & McGoogan, JAMA 2020 Feb 24 [Epub ahead of print]). Which of the… 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 12mo old child with immunizations up to date presents with fever and rash. Which of the following distributions is concerning for measles?
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(Click the link to comment and to vote – voting not working through email, sorry!) Pediatric patients with sickle cell anemia have a higher susceptibility to becoming infected with which organism?
(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!) An 8 year old boy comes in with 2 days of fever, chills, myalgias, headache, and a few episodes of non-bloody, non-bilious vomiting. He also… 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 →
Respiratory virus season is here, and we all know that the FDA recommends against the use of OTC cough medications in children < 4 years old (due to too many adverse effects and lack of efficacy). Some studies have shown… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 2.5 month old baby who underwent a fever work-up yesterday and has been called back due to a positive blood culture… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Which of the following is/are true of bacterial tracheitis? Children presenting with bacterial tracheitis tend to be older than children presenting with viral croup Children… Continue Reading →
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(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 12 year old girl with PMH of sickle cell disease complicated only by 2 lifetime hospitalizations for vasoocclusive pain crisis. She… Continue Reading →
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(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 →
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(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 10 month old with symptoms consistent with varicella. The infant is well-appearing, has no complications, and is 3 days into her… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a child with fever and rash x 1 day. Cognizant that we are in the middle of a measles outbreak, which of… 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!) Which of the following topical antibiotics has the least efficacy against impetigo? (see pictures of impetigo here and a short article here)
(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 5 year old girl presents with a 2 cm tender lump in her right armpit. It is not fluctuant and there is no overlying… 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 10 year old recently moved to the U.S. from Mexico with left sided chest pain for one day, and a fever… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A 5 month old comes in with diarrhea x 3 days, 5 times per day initially now 3 times per day, non-bloody, no fever, no… 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 an 8 month old child with viral URI symptoms and pulling at the left ear. The child has not had any fever,… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 5 year old child with cochlear implants placed 8 months ago. The child has fever, headache, vomiting, altered mental status, and… Continue Reading →
Staying with the topic of urine… investigators at University of Pittsburgh have derived and validated a UTI risk calculator for patients aged 2-23 months. The calculator (UTICalc) is linked from the On Shift page of PEMsource under the heading Neonatal… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A 2 year old is brought in because all of his fingernails and toenails are falling off, painlessly. On review of the ED electronic medical… 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!) A 5 year old was bitten by the family cat superficially on his right index finger, 3 days ago. He presents now with redness, warmth,… 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!) Several members of a family present to the cruise ship infirmary of an Alaskan cruise. They just ate a lunch consisting of tuna salad sandwiches…. Continue Reading →
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… Continue Reading →
http://diseasespictures.com/ What is the best treatment for this 3 year old patient’s rash? (Click the link to comment and to vote – voting not working through email, sorry!)
You are caring for a 6yo oncology patient presenting in septic shock. Although he is oxygenating and ventilating well at this time, you plan to intubate him to reduce his metabolic work. The most important pre- treatment before rapid sequence… Continue Reading →
A 12yo girl presents to the ED in December with fever for 4 days, malaise, and pain in the right thigh gradually leading to her having difficulty walking. There is no history of trauma, although she did play a lot… Continue Reading →
Placing topical anesthetic (EMLA, LMX4) on skin abscesses may result in spontaneous drainage, precluding need for incision. If topical anesthetic doesn’t result in spontaneous drainage, it at least provides some skin anesthesia prior to local anesthetic injection for incision and drainage procedure…. Continue Reading →
A 16yo girl presents to the ED with symptoms and rash consistent with varicella (chickenpox). She was never vaccinated, as a personal family choice. She also recently gave birth. (Click the link to comment and to vote – voting not… Continue Reading →
A 10yo boy obtained a pet rat from a commercial pet store. Upon returning home, his new pet promptly bit him. 5 days later, he has fever, chills, severe headache, polyarthralgias, and a maculopapular rash with some petechiae that developed… Continue Reading →
Which of the following wild animal exposures is the lowest risk for rabies? Skunk Coyote Raccoon Fox Rabbit Also, if you’re interested in the Peds ID Antibiotics Question of the Week, you can find it here
Which of the following is true about Clostridium difficile? A. It is the most common cause of antibiotic-associated diarrhea B. The treatment of choice for C. diff colitis is IV vancomycin C. Asymptomatic carriage in children < 1 year old… Continue Reading →
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… Continue Reading →
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… Continue Reading →
Use a glass test tube or specimen tube to press on a rash to see if it blanches – remember, petechiae and purpura don’t blanch. You can also use a glass test tube as a mini-anoscope to blanch surrounding mucosa… Continue Reading →
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… Continue Reading →
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?
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