Clinical Pediatric Emergency Medicine最新文献

A 12-month-old female presented to the pediatric emergency department with constipation associated with urinary retention. This visit was one of several for constipation over the course of several weeks. She had been treated for functional constipation with dietary changes and an osmotic agent without relief and required one hospitalization for a bowel clean out. It was during her second admission, where she required frequent bladder catheterizations for urinary retention, that a diagnostic study was done which revealed the correct diagnosis.

A 14-year-old healthy male adolescent presented to the emergency department with a 1-month history of vomiting and was found to have severe hypertension secondary to renal failure. After a prolonged hospitalization and extensive workup his ultimate diagnosis was revealed. This case highlights the etiology and workup of hypertension as well as differential of hypertension and renal failure in the adolescent population.

A 7-day-old female infant presented to the emergency department with a chief complaint of bruises. She was found to have severe coagulopathy. Initial management focused on identifying and treating complications of the coagulopathy without causing harm to the patient. Further workup was performed with the assistance of hematology experts to determine the underlying cause. Ultimately, the patient's diagnosis was determined by a single laboratory test. This patient's presentation allows us to review the workup of neonatal coagulopathy with special attention to potential pitfalls one might encounter in the management of these patients.

A previously healthy 20-year-old man presented to the emergency department with difficulty walking and bilateral heel pain. His pain started acutely in the right heel approximately 3 months prior to presentation with no known trauma or injury. He had previously been treated with steroids for presumed tendinitis and magnetic resonance imaging of his ankle showed a possible partial tear of the right Achilles tendon. His pain worsened and involved swelling of both heels so that he was unable to walk. On presentation, he had a normal neurological exam. His musculoskeletal exam was pertinent for pain over the calcaneus bilaterally and swelling with firmness over both Achilles tendons. Labs were notable for an elevated uric acid, and a computed tomographic scan of his feet showed the presence of monosodium urate crystal deposition, consistent with a diagnosis of gouty arthritis. Despite gout being a disease diagnosed almost exclusively in adults, pediatric providers must consider this and other diseases that typically affect adults, especially when treating patients at the older end of the pediatric spectrum.

Altered mental status is an emergency that significantly contributes to morbidity and mortality in children, and thus, requires rapid and thorough evaluation. Identification of the underlying cause of altered mental status is crucial for appropriate clinical management. With a presentation of hyperglycemia and a family history of diabetes mellitus type 2, an astute physician would consider metabolic encephalopathy as the cause of altered mental status. We describe a critical case of altered mental status in a 14-year-old obese male adolescent with no history of chronic illness or surgeries who presented to the emergency department with hyperglycemia.

A 17-year-old male adolescent presented to the emergency department initially with abdominal pain and headache which progressed to neck swelling and vision changes over a period of several weeks. He was noted to have a 4 cm by 4 cm right supraclavicular lymph node and visual acuity of 20/200 in the right eye and 20/70 in the left eye. Further testing, imaging, and a thorough history revealed the source of his illness and unusual ophthalmologic findings.

A 17-year-old girl with a history of anxiety and emotional dysregulation presented to the emergency department with abdominal pain, weight loss, dizziness, and vomiting. She had previously been prescribed several medications for ongoing somatic and psychiatric complaints, but her symptoms continued to escalate. She was noted to have significant weight loss, orthostatic hypotension, a prolonged QTc on electrocardiogram, and a serum sodium of 130 mEq/L. She was admitted with concern for an eating disorder. While inpatient, her symptoms continued to evolve, and a test was sent that revealed her underlying diagnosis.

A 3-year-old male presented to the emergency department with two episodes of abdominal pain, 1 week apart. His evaluation was unrevealing, but he was admitted for continued bouts of severe, intermittent abdominal pain. Further history obtained the day after admission revealed the cause of his symptoms and the ultimate diagnosis.

A 2-year-old previously healthy girl presented to the emergency department with sudden onset of nonbilious emesis and severe abdominal pain. Her clinical examination and point-of-care ultrasound were consistent with a small bowel obstruction. She had sonographic evidence of free fluid in the abdomen and subsequently developed hemodynamic instability. Further imaging was suggestive for a congenital anomaly causing her obstruction. She was ultimately diagnosed with an omphalomesenteric duct remnant, confirmed during an exploratory laparotomy.