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EM@3AM: Meningococcal Disease

A 12-year-old girl presents to the ED with a 2-day history of headache and fever. The patient started vomiting with fevers this morning, and her mother was unable to wake her from her afternoon nap. She is lethargic and responds to painful stimuli with temperature of 38.2 C, blood pressure 88/65 mmHg, and HR 132 bpm. She has a petechial rash on her lower back and lower extremities, as well as resistance to neck flexion. What is the diagnosis?

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    Articles

    Bounceback: An Unrelenting Headache

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    CC: Headache First visit HPI: 29 year old female with a prior history of headaches, presented with two days of gradual onset, atraumatic, right sided headache that is throbbing in nature. The patient reported heaviness about the eye but no visual changes or disturbances. No neck pain, fevers, chills. She
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    • practice updates

    Don't be RASH: Emergency Physician's Approach to the Undifferentiated Lesion

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    Editor's note: This post was listed in both the #FOAMED Review from EM Curious AND in the LITFL Review 154 "Best of #FOAMed" section.

    As an EM physician, it is difficult to have working knowledge of the hundreds of different types of rashes that exist. However,

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    Left Bundle Branch Block in Myocardial Infarction: An Update

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    Editor's note: This article was listed in the LITFL Review 154's "Best of #FOAMed" section.

    The left bundle branch arises from the Bundle of His, and subsequently is divided into the anterior and posterior fascicles. The anterior fascicle is usually supplied by septal perforators from the Left Anterior

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    • practice updates

    Ventilator Management in COPD

    • 4 Comments
    Editor's note: This post was listed in the #FOAMED Review (17th Ed.) from EM Curious. It ALSO appeared in LITFL Review 154's "Best of #FOAMcc Critical Care" section.

    Its 7:01am. Your shift in your department’s high acuity area is just beginning, and you are waiting to

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    • practice updates

    Platelets and ddAVP in the Management of Intracranial Hemorrhage

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    Evidence-based guidelines and information for the management of intracranial hemorrhage in patients taking anti-platelet agents
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    • practice updates

    Outpatient PE treatment

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    Editor's note: This post was listed in the LITFL Review 153's "Best of #FOAMed" category. Venous thromboembolism (VTE) (deep vein thrombosis or pulmonary embolism) has an incidence of roughly 1 in 1,000 with an incidence of PE with or without DVT of 2.3 per 10,000. One major factor to
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    Anatomic urinary obstruction in septic shock

    Occurs in 10% of those with septic shock due to urinary source

     

    Associated with 27% mortality

     

    Administer antibiotics, resuscitate, consult urology for source control

     

    PMID: 26905806

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