A 21-year-old male is brought to the ED via EMS after a reported seizure. As per girlfriend, the patient began complaining of a headache yesterday, and today he is confused. He is febrile and tachycardic. He is confused and has nuchal rigidity. However, Kernig and Brudzinki signs are negative. CT is negative. What is most likely diagnosis, and what is the next step in diagnosis?

A 13-year-old male presents to the ED for aggressive behavior which progressed to confusion and decreased level of consciousness. He initially was very agitated and aggressive and refused to drink any water. He then became disoriented and is now difficult to rouse. The parents note that he had recently had a fever, sore throat, and general malaise prior to this behavior but those symptoms resolved, although they note excessive salivation. Review of systems is remarkable for a bat bite for which he never sought care. He is tachycardic, tachypneic, febrile, and appears toxic. What’s the most likely diagnosis?

A 17-year-old male with history of asthma presents to the ED with a chief complaint of sore throat for the past 3 days, associated with decreased oral intake. He denies sick contacts. Vital signs include Temp 100.6F, BP 124/78, HR 92, RR 16, 96% on RA. On exam the patient has swollen, erythematous tonsils with grayish exudate, as well as enlarged, tender anterior and posterior cervical chain lymph nodes. What is the most likely diagnosis?

A 3-month-old male presents with persistent fever, decreased oral intake, and worsening cough associated with post-tussive emesis for the five days. Parents state that the patient’s older sibling has had similar symptoms for the past two weeks and that neither child has received vaccinations after birth. The patient presents with BP 98/64 mm Hg, HR 160, RR 62, T 38.1ºC. Physical exam demonstrates an ill-appearing infant with bilateral conjunctival hemorrhage, dry cough, and inspiratory “whooping” sound. What is the most likely cause of this patient’s symptoms and what are the next steps in management?

In recent weeks, clusters of cases have been described in several countries prompting us to revisit this topic as it is not one we typically deal with in the ED.

This post covers the presentation, evaluation, and management of empyema.

A 56-year-old male with a history of type 2 diabetes presents to the ED with a rash on his right shin that started two days ago and has progressively worsened. He has associated mild pain but has not taken any analgesics. Vital signs include HR 90 bpm, BP 148/100, RR 16, T 100.2F, and SPO2 96%. Examination is significant for an obese disheveled male in no acute distress. His right shin has a large area of erythema with indistinct margins and increased warmth, as well as associated mild tenderness to palpation. What is the most likely diagnosis?

Let us take a brief moment to remember a once common concern that is, fortunately, less often seen – Meningitis in Children.