Gamechanger: Do we really need a lumbar puncture for all febrile infants 0-28 days old?
A new international pooled analysis challenges the age-old dogma that all febrile infants 0-28 days require a lumbar puncture (LP). Can the PECARN febrile infant prediction rule safely identify a low-risk subset for invasive bacterial illnesses (bacterial meningitis and bacteremia) [1]?Bottom LineFor more than four decades, the standard of care for febrile infants in the first month of life has been aggressive: full sepsis workup (including an LP), admission, and IV antibiotics. A new study in JAMA suggests this paradigm may be shifting [2, 3].In an international pooled analysis of more than 1,500 febrile infants aged ≤28 days, the updated [+]
SAEM Clinical Images Series: I Cannot Control My Right Side
The patient is a 47-year-old female whose past medical history includes ESRD on dialysis, type 1 diabetes, and hypertension, who presents to the Emergency Department for uncontrollable right-sided movements of her body. The patient states these symptoms have been present for several weeks and have progressively worsened over the past week. She reports difficulty with ambulation secondary to these involuntary movements of the right side of her body. She denies any missed dialysis sessions. She denies fever, headaches, sensory problems, or any [+]
SAEM Clinical Images Series: Ocular Trauma Following Ground Level Fall
The patient is an 82-year-old female who presents to the Emergency Department after an unwitnessed fall from standing approximately 2 hours prior to arrival. The patient states that she thinks she lost her balance and fell, striking her face. She denies loss of consciousness or any antecedent dizziness or presyncopal symptoms, but has limited recollection of the event. At presentation, she reports pain to the left side of the face, a laceration to the left side of her face, and decreased vision in her left eye. She has [+]
SAEM Clinical Images Series: No, I Am Not Diabetic!
The patient is a 72-year-old male with a history of CAD, hypertension, and BPH who presents to the Emergency Department for sinus congestion and right-sided facial pain. The patient reports progressively worsening darkening crusting around his nose for 3 weeks. He has also had a right-sided temporal and retrobulbar headache, blurry vision in right eye, diminished sense of smell, and right sided numbness to the roof of his mouth for the past week. He was prescribed amoxicillin and nasal steroid spray four [+]
SAEM Clinical Images Series: Snorkeling Gone Wrong!
The patient is a 30-year-old female who presents to the Emergency Department with severe left foot pain after snorkeling in shallow water off the coast of Phuket, Thailand. She reports a sudden onset of pain as she was kicking her legs while swimming. She describes the pain as burning in nature across the top of her foot, which worsens with weight bearing, though she can bear weight. She also complaints of multiple discolorations on the dorsum [+]
SAEM Clinical Images Series: Caught by the Cuff
A 74-year-old male with a history of hypertension and moderate alcohol use presented to the Emergency Department with generalized weakness. He was started on low dose furosemide once a day for mild ankle swelling 3 days prior. He reported good oral intake but noted that he had been urinating more than usual. He denied any fever, chest pain, shortness of breath, or any other problems but due to worsening weakness he came in for evaluation. Vitals: BP 185/94; HR 90; R 18; T 97.4°F; O2 sat 98% [+]
ACMT Visual Pearl: Basal Ganglia Hemorrhage
Which toxic alcohol can cause a basal ganglia hemorrhage? Ethanol Isopropanol Methanol Propylene glycol [Left image from Wikimedia Commons] [+]
Fernanda Calienes-Cerpa, MD
Wake Forest Emergency Providers
Latest posts by Fernanda Calienes-Cerpa, MD (see all)
SAEM Clinical Images Series: Mind the Gap
A 25-year-old right-handed female with a longstanding history of right wrist pain presents with wrist pain. Her chronic pain had worsened over the past 2-3 weeks. She did not recall a specific recent injury, but did recall that she had a painful injury to the same wrist in the past when she fell on her outstretched hand. She was seen several weeks prior for the injury, but did not seek follow-up care after her initial evaluation. She had pain with any movement and complained of tenderness around the wrist, but denied [+]
SAEM Clinical Images Series: Strawberry Tongue
A 7-year-old male with no significant past medical history presented to the Emergency Department complaining of a sore throat. The parents stated that he had been running fevers for two days along with a worsening sore throat. The patient had been able to swallow, but had decreased oral intake secondary to pain. There are no other complaints at the time. Vitals: BP 110/70; HR 111; R 17; T 101°F; O2 sat: 99% on room air. General: Well appearing, no acute distress, normal voice. HEENT: There is no [+]
SAEM Clinical Images Series: Leg Rash
A 42-year-old male with no significant medical problems presented to the Emergency Department with a 5-week history of abdominal pain and bloody diarrhea. He also reported painful intraoral blisters and ulcerative lesions on the bilateral lower extremities and scrotum. The patient had been self-managing his symptoms with over-the-counter antidiarrheal medications and has unsuccessfully attempted to establish care with a gastroenterologist. He denied any history of intravenous drug use, cutaneous injections, or previous skin infections and has no other complaints at this time. Vitals: BP 125/85; HR 97; [+]