Case presentation A 9-year-old female seeks care after falling from her bicycle. She states that she was riding her bike and attempted to “pop a wheelie.” In doing so, she fell backward, separating herself from the bike, landing initially on her buttocks, but then onto her back. There is no reported loss of consciousness and she was wearing a helmet. She denies neck pain. She did…
Case presentation A 12-month-old female presents following a motor vehicle accident. The child was reportedly secured in a rear car seat; however, the child was found outside of the vehicle lying on the pavement. The two-vehicle crash occurred at a high rate of speed (70–80 miles/hour), and there was considerable damage to both vehicles but no deaths at the scene. In the Emergency Department, the child…
Case presentation A 17-year-old male presents to the Emergency Department after being shot in the back. He reports chest pain and dyspnea. His vital signs are a heart rate of 110 beats per minute, a blood pressure of 110/75 mm Hg, and a respiratory rate of 25 breaths per minute. His physical examination is significant for an entry wound in his right axilla without any obvious…
Case presentation A 12-year-old male presents with an injury to the chest. Apparently, he was “playing” with a nail gun and it went off, causing a nail to enter his chest. The child’s vital signs show an afebrile patient, who looks apprehensive, pale, and diaphoretic. His heart rate is 112 beats per minute, respiratory rate is 22 breaths per minute, blood pressure is 112/62 mm Hg,…
Case presentation A 13-year-old is brought to the Emergency Department after being struck by a large truck while attempting to cross a highway on his bicycle. There is no reported loss of consciousness. His vital signs show an afebrile patient with a heart rate of 120 beats per minute, respiratory rate of 28 breaths per minute, blood pressure of 100/70 mm Hg, and a pulse oximetry…
Case presentation A 7-month-old child presents to the Emergency Department after rolling off a couch. The child’s mother, who is visibly distraught and is worried that “her child’s brain is ruined,” reports that the child fell off the couch and struck the hardwood floor. The distance of the fall is approximately 2–3 feet. The child immediately cried and since the event, which occurred about 1 hour…
Case presentation An 8-year-old female is brought into the Emergency Department by private vehicle after being run over by a car. The child was in her driveway when her father, who was backing the family van out of the garage, struck and ran over her. She is accompanied by both of her parents. The mother corroborates the father’s history. There is no reported loss of consciousness…
Case presentation A 16-year-old male presents with left-sided chest pain for the past week. He states that the pain began during band practice. He plays the trombone and states that he “must have pulled a chest muscle” because he was “playing really loud.” He immediately felt the pain but continued playing. He reports no shortness of breath, but the pain is worse with deep inspiration and…
Case presentation A 4-year-old male arrives via air ambulance after being involved in an all-terrain vehicle (ATV) accident. The child was riding with his older sister (he was in the front, riding on his sister’s lap) when the ATV turned over at a high rate of speed, causing the vehicle to flip onto the child. The ATV was pushed over by his father and several other…
Case presentation An 8-year-old boy presents with 3 days of cough, fever, and headache. He had been seen the previous day by his primary care physician and he was told to come to the Emergency Department after a chest x-ray performed as an outpatient demonstrated findings concerning for pneumonia. Six weeks ago, he was diagnosed with a right lower lobe pneumonia and treated with oral amoxicillin…
Case presentation A 12-year-old male with a history of autism presents with cough for the past 3 weeks. There was initially fever to 102 degrees Fahrenheit, but this lasted for 2–3 days, then resolved. He was seen by his primary care provider 2 weeks ago and was diagnosed with a viral upper respiratory infection. He has not had congestion, vomiting, diarrhea, or abdominal pain. There is…
Case presentation A 22-month-old female presents with cough and congestion for the past 5 days. She was noted to have persistent fever to 102 degrees Fahrenheit. She has been taking oral fluids well, but this has decreased over the past few days, although she still has good urine output. There has been no vomiting, diarrhea, or concern for foreign body ingestion/choking episodes. Her physical examination reveals…
Case presentation A 7-year-old male with a medical history of asthma presents with 7 days of cough and “not feeling well.” Four days ago, the patient developed fever to 103 degrees Fahrenheit. He was seen at his primary care provider 2 days ago and started on azithromycin, but he has not been eating or drinking well for the past several days and has had decreased urine…
Case presentation A 16-year-old female presents with a history of severe headaches, nausea, and vomiting for the past 3 weeks. She was seen at an urgent care facility where she was diagnosed with sinusitis and was given prescriptions for odansetron, prednisone, and amoxicillin. After several days of these medications, she did not experience any relief, so she was seen by her primary care provider. She was…
Case presentation A 7-month-old baby presents with left infraorbital swelling and erythema for the past 2 days, which has progressed rapidly. There has been a fever of 101.5 degrees Fahrenheit for the past 24 hours. He has not had cough, congestion, vomiting, or diarrhea. Four days ago, the child was playing with his older sibling, who, during the course of play, threw a small toy car…
Case presentation A 10-year-old male presents with left eye edema and pain for the past 2–3 days. The child reports mild congestion for the past week but there has been no fever, vomiting, cough, vision changes, eye discharge, or trauma. He states that it is difficult for him to completely open the eye because of the swelling. When he does, he complains of generalized eye pain.…
Case presentation A 13-year-old male presents with acute onset of mental status changes. He was found in his room, lying facedown. Emergency medical services was called. On their arrival, the patient was conversing but appeared sleepy; he was responsive to questions but confused. He was attempting to speak but was able to manage only a few words. Once in the Emergency Department, the patient was able…
Case presentation A 2-year-old child presents with difficulty ambulating for the past 24 hours. His parents state that the child has had fever, cough, and congestion for the past 5 days. He was seen twice by his primary care provider and diagnosed with a viral upper respiratory infection. A chest x-ray 1 day ago was interpreted as consistent with a viral process. The parents tell you…
Case presentation A 20-month-old patient presents with decreased activity, including eating and drinking, over the past 2 days. He is currently completing a second course of oral antibiotics for acute otitis media and 1 week ago completed a 10-day course of cefdinir. He was especially sleepy today, per the parents, who decided to bring him to his primary care physician for evaluation. He was also found…
Case presentation A 17-year-old male presents with right-sided facial numbness and extremity weakness that has been intermittent for the past 1 month. Several hours ago, the patient noted he had difficulty ambulating when rising out of bed due to the weakness, causing him to fall. He was able to prevent injury by steadying himself on a chair. He went back to lie down and then called…