First Place EMages Winner 2015: Neck Pain

Megan Marino, MD

Baylor College of Medicine and Texas Children’s Hospital, H uston, Texas

Department of Pediatrics, Section of Emergency Medicine

CASE  PRESENTATION

9 year old female with history of acute lymphocytic leukemia (ALL), status post heart transplant 9 months ago for chemotherapy related cardiomyopathy, presented to the emergency department with 4 weeks of worsening neck pain and 2 days of dysphagia and voice changes. She stopped moving her neck, refuses solids, but is able to drink liquids. She has been afebrile.  She has been seen twice by other providers over the last month, was diagnosed with torticollis, and given diazepam and acetaminophen with codeine without improvement. Home medications included tacrolimus, mycophenolate and prednisone. read more

Second Place EMages Winner 2015: It’s All in the Eyes

Camilo E. Gutiérrez, MD, FAAEM

Boston Medical Center / Boston University School of Medicine

CASE PRESENTATION

A 17 year old teenager presents as a new immigrant from Haiti for evaluation of “heart murmur” diagnosed there. Has no immediate family with him so past medical or family history is unclear. He is on no medications and denies drug abuse.

Complaints of occasional chest pain, palpitations and shortness of breath.

His vital signs are within normal limits.

On examination patient is noted to be tall and thin, pectus excavatum and high arched feet. Has evidence of scoliosis, fingers are long and thumbs are very lax. Lung exam is normal. Cardiovascular exam is remarkable for a holosystolic murmur with mid-systolic click, heard best at the apex and accentuated by valsalva. Mental status is normal. Neurologic examination is also within normal limits. read more

Third Place EMages Winner 2015: Pediatric Rash with Fever, When History and Physical are Paramount

Andres Bayona, MD, Robert M Lapus, MD

Department of Emergency Medicine, University of Texas Medical School at Houston, Houston, Texas

Children’s Memorial Hermann Hospital, Houston, Texas

CASE PRESENTATION

A one month old girl with a history of congenital complete Atrioventricular (AV) block with an implanted pacemaker placement on day of life 6, presented to the Emergency Department (ED) with rash and fever. One week prior to presentation she developed a rash on her face, which slowly spread to her chest, abdomen and extremities. On the day of presentation she developed a fever at home. Mom brought her to the pediatrician, who then referred them to the ED. read more

Ruminations and Transitions on Life as a PEM Fellow

Life happens.

In a matter of seconds, life can change from one extreme to another.
Some recent examples that come mind are:
A 4-year old boy wearing Superman pajamas, just diagnosed with a brain tumor.
A 9-year old girl who is scared of doctors, diagnosed with acute appendicitis and in need of surgery.
A 12-day old boy with persistent fussiness with HSV meningitis.
A 13-year old girl playing Candy Crush on her iPad with new-onset diabetes.
A 17-year old boy taking a Calculus final exam in school found unconscious. He was in ventricular tachycardia. read more

What is new in Patient Experience? Updates from the Cleveland Clinic Summit May 17-20, 2015

Since the publication of the Institute of Medicine (IOM) report from the Committee on the Quality Healthcare in America in March 2001, an increasing trend in patient-centered care has emerged in many areas of healthcare. As a result of this, patient satisfaction has become a key quality indicator. Many healthcare organizations have begun to conduct patient satisfaction surveys and use the data from these surveys to develop metrics and key drivers for service. The annual Patient Experience Summit at Cleveland Clinic, 4-day conference where key stakeholders from around the country gather to exchange stories of success and strategies for better delivery of healthcare services to patients, is where this all comes together. read more