#FOAMped

Small Talk is back with BRUEs.

Ready for the latest American Academy of Pediatrics Guidelines for the Febrile Neonate? This edition of Pediatric Small Talk gives you what you need to know.

Welcome to the inaugural post of Small Talk; a new monthly section from emDOCs.  Every first Wednesday of the month we will release high yield PEM content written by PEM talent from around the country.  Today we discuss pediatric stroke.

This week the emDOCs podcast covers an important myth: the association of strep throat and rheumatic fever.

A previously healthy 2-year-old boy presents with 3 days of recurrent nosebleeds. He had no adverse birth history and is up to date on his vaccinations. The patient’s mother denies any known trauma and the patient denies picking his nose. In addition, he has no fever, headaches, nausea, hematuria, dysuria, vision changes, or known toxic ingestions. The patient’s uncle previously had issues with bleeding after surgery. Physical exam is remarkable for ongoing epistaxis via bilateral nares. Initial laboratory results include white blood cell count 10,900/μL, hemoglobin 10.9 g/dL, platelet count 200 × 103/μL, APT 45.6s. What’s the diagnosis, and what are your next steps in evaluation and management? 

A 3-year-old male presents with pallor and nosebleeds. On exam, the patient looks pale and has petechiae across his arms and back. His spleen is palpable. Labs reveal white blood cell count 20,900/μL, absolute neutrophil count 10,400/μL, absolute lymphocyte count 1800/μL, hemoglobin 5.9 g/dL, and platelet count 20 × 10^3/μL. What’s the diagnosis?

A 3-month-old male is brought in for increased work of breathing for the last 4 days. The patient has had no fevers or sick contacts. He was born full term without complications, is fully vaccinated, and has no familial medical history. Triage vital signs (VS): BP 85/50, HR 152, RR 56, SpO2 92% on room air, oral temp 99.9. The patient is tachypneic with weak cry, but has normal pink color. There is a 4/6 holosystolic murmur, with 2+ femoral and brachial pulses. He has suprasternal and intercostal retractions with wheezes. There is also palpable hepatomegaly. What are your next steps?

A 3-day full term male presents with poor feeding and lethargy, looking grey. He is diaphoretic with feeds. He has not gained weight since birth. He is afebrile, tachycardic, tachypneic, grey appearing, with cool extremities and poor capillary refill. What should you consider?

A 6-day-old male presents with increased work of breathing for last 4 hours and an episode of turning blue, which concerned the family. The baby is lethargic, afebrile, and cyanotic, with a weak cry to stimulation. There is a sunken fontanelle, perioral cyanosis with purple intra-oral mucosa, and blue tongue. He is tachypneic and has mild retractions, clear lung sounds, and dullness to percussion 4 cm past right costal margin. There is poor tone and mottled extremities. What should you consider?