Emerging enterovirus cluster: Will you test in your ED?

Parts of the American Midwest and Southeast have been experiencing an unusually high number of significant respiratory illnesses among children. Likely caused by a enterovirus, this particular outbreak has resulted in news-worthy levels of hospitalizations for severe respiratory distress. Mark Pallansch PhD, the director of the Division of Viral Diseases at the CDC recently appeared on CNN to address clusters of cases and called the hospitalizations potentially the “tip of the iceberg.” If indeed the number or severity of enterovirus-related cases rises, parents will rightly ask us about Read more [...]
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Answer: “To Drain Or Not To Drain? That Is The Question.”

This post is in response to the August Ultrasound Image of the Month: “To Drain Or Not To Drain? That Is The Question." To summarize, we had a febrile 1-year-old male presenting to the ED with a 2cm area of redness and induration behind that right knee that was concerning for a soft tissue infection. A point-of-care ultrasound was performed and the following clip was obtained, suggesting an abscess.   Thank you to all of you who took the quiz! Here are your results below: Only 18% guessed correctly that this patient had an abscess.  Most respondents were split between Read more [...]
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To Drain Or Not To Drain? That Is The Question.

A 1-year-old male presented to the ED with fever and a 2 cm area of redness and induration behind the right knee that had been growing in size for the past 3 days. The Pediatrician had given the family a prescription for topical mupiricin, but sent the patient to the ED for further management of the skin infection and fever. There was no history of trauma. Upon arrival to the ED, the child was febrile to 101°F and cranky but consolable. He was able to bear weight and toddle around the room, but was particularly tender to palpation behind the right knee. On further inspection, the skin posterior Read more [...]

Top 10 reasons to become a PEM doc

If you view Labor day weekend as an opportunity to work a weekend shift that is less crowded (until monday and the gastros roll in) then yes, you just may be a PEM doc (or one in the making). Summer is almost gone, and that means applicants are coming soon.  So whether you actually escaped to one last weekend a the beach, or if you are doing a shift - here is a post on the lighter side in honor of interview season.  (and let's see some comments- maybe we can expand this list from top 10 to 50?).  Ok here we go: The top 10 reasons to go into Pediatric Emergency Medicine You Read more [...]

Wake Up America! It Costs One Million Dollars to Become a Doctor!

After my last post, I had a conversation with a friend of mine who practices law in New York. Our discussion focused on how much doctors are being paid compared to lawyers. My friend considers me lucky, as I had a scholarship that paid the tuition for my education. I am fortunate that this is true, but the majority of physicians take out substantial loans to pay for their education. So I decided to create a list of what it costs to be a pediatric emergency physician in the United States. Medical School Tuition: A 20-year loan anywhere between $219,000 and $287,000, with interest between Read more [...]

Making broken bones better

The summer is a magical time when people who have been trapped inside by months of rain, snow, and the cold of the winter and spring emerge to find warmth, festivals, and vibrancy. As a PEM physician, the summer also means injuries. For example, to most people a bouncy castle is a symbol of childhood joy and freedom wrapped in a giant rainbow-colored beach ball. To me, it is a supracondylar fracture in waiting. Since one study of pediatric forearm fractures found that only 7% of patients did not need analgesia at home perhaps the next question should be what should you prescribe? Tylenol Read more [...]
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Answer: “The Lure of Ocular Ultrasound”

This post is in response to the August Ultrasound Image of the Month: “The Lure of Ocular Ultrasound.” To summarize, we had an obese teenage female complaining of weeks of headache that failed to respond to over-the-counter medications or intravenous medications. An ocular ultrasound was performed and the following image was performed which demonstrated papilledema as well as a enlarged optic nerve sheath diameter (ONSD) suggestive of Idiopathic Intracranial Hypertension (or pseudotumor cerebrii).  Her lumbar puncture demonstrated a significantly elevated opening pressure with an otherwise Read more [...]
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The Lure of Ocular Ultrasound

  This was an obese teenage female who had presented to the ED after being evaluated at multiple other hospitals for 3 weeks of persistent headache. Her headaches did not respond to over-the-counter medications or intravenous medications at the outside hospitals, and she came to CHONY for further management.  She endorsed photophobia but denied fevers, neck pain, nausea, vomiting, new medications, or trauma.  On exam, she had no neurological symptoms and no papilledema. However, it was noted that it was a challenging ophthalmologic exam due to her photophobia. Coincidentally, Read more [...]