2019 EMage Contest First Place Winner: Helluva Uvula

Evan Laveman, MD Emergency Medicine PGY3
Kelly Kelley, MSN, RN, CPNP, CNS
Christopher Redgate, MD, MS, PEM Fellow PGY6

Pediatric Emergency Department, Department of Emergency Medicine, Harbor-UCLA

16-year-old male with no past medical history presented to the Pediatric Emergency Department (PED) for 4 months of nasal congestion worsening over the past month. He immigrated from Honduras with his father 20 days ago and over this time noticed a decreased ability to breath through his nose. Most troubling, he started to develop foul smelling nasal discharge mainly through his left nare. His only medical contact had been at a U.S. clinic when he first arrived where he was prescribed a nasal spray and cetirizine with no relief. He felt moderate sinus pressure but denied weight loss, fevers, chills, headache or vision changes. read more

DON’T BE BASIC—Caustic Ingestions

Jonathan Eisenberg, MD

It would seem a poor idea to take medical advice from non-medical professionals, for example a president with no formal scientific background, in the realm of toxic and caustic ingestions. Although cola soda should be considered caustic, the true dangers lie mostly underneath the kitchen sink and bathroom. Acid and Base ingestions are reported to be in the range of 5-15 thousand cases per year. There is a bimodal distribution of age groups affected—those under 6 year of age making up a large portion and the other being greater than 21 years of age. The pediatric and adult populations generally have different motivations behind the ingestion—exploration versus self-harm—in the vast majority of cases. Given the difference in volumes ingested in accidental cases, children have lower fatality rates than teenagers or adults. The absence of singular severe symptoms (e.g., oral lesions, vomiting, drooling, dysphagia, hematemesis, dyspnea, abdominal pain) does not reliably indicate future injury or pathology but the presence of three or more symptoms is associated with a higher likelihood of significant injury. read more

Firecracker and Blast Injuries

Jonathan Eisenberg, MD

As a child, my father told me a story about his neighbor who had a mishap with a firecracker and blew off the second through fourth digits.  He would then hold out his thumb and pinky and wave to me.  This scared me to such an extent that I still have never lit a firecracker, even during my less frontal lobe-oriented teen years.  I now think that this story was a fabrication—but it is not that far off from its realistic basis.

Fireworks are most popular during the month surrounding July 4th in the US.  These colorful combustibles have been around in the US since July 4th, 1777, and we spend more than $700 million dollars per year on them.  There are many varieties and categories from novelty and daytime fireworks (both generally have smaller explosions) to the larger aerial fireworks and a host of nuanced state laws which allow for an all, some, or none approach to sales. read more

Severe Acute Respiratory Syndrome Coronavirus-2 and Multi-system Inflammatory Syndrome in Children: Preliminary Reports

By Nicholas Pokrajac, MD, Co-editor

What is the Multi-system Inflammatory Syndrome in Children (MIS-C)?

Most children infected with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) have a mild course of illness.1 However, there have been recent reports of a number of children developing a condition with similarities to Kawasaki disease (KD) and toxic shock syndrome (TSS) within epicenters of the SARS-CoV-2 outbreak, including over 200 children in New York, Italy, and the United Kingdom. This condition has been named the Multisystem Inflammatory Syndrome in Children (MIS-C). As of May 14, 2020, the Centers for Disease Control and Prevention (CDC) recommends reporting of suspected cases to their local or state health departments. This article is a brief summary of preliminary reports on MIS-C to serve as a primer for emergency clinicians. read more

Let’s Talk About Sex

Atsuko Koyama, MD, MPH

As an adolescent and pediatric emergency medicine specialist with an interest in reproductive health, I was asked to write about adolescents and sexually transmitted diseases (STDs). So, I’ve put together a potpourri of important, but not as commonly discussed, issues to help improve adolescents’ and your lives, with two caveats. 1) These are NOT recommendations for sexual assault or child abuse cases. 2) There are apps and websites at the end of this article for further information. These tidbits are more for what to think about when caring for an adolescent who might be sexually active… AKA every adolescent. read more