A 17-year-old female with no past medical history presented to the emergency department for 3 weeks of claudication. A week prior to her symptom onset, patient describes a brief illness that included abdominal pain, nausea, vomiting, fever, headaches, and fatigue. She was seen at an urgent care at the time and prescribed a Zpack. She was told her blood pressure was abnormally high, but could not recall the numbers, and the doctor advised it was likely anxiety. A few days after, she was feeling better, but began to have pain in her legs when walking. She did not have any pain at rest. She reports the pain in her legs worsened over the next few weeks, where she became unable to walk across a room without severe pain in her lower legs. The pain started in her calves and extended up to her thighs and even up to her abdomen. She described numbness and tingling in her lower extremities as well, and that her legs felt “cooler” to her. She denied any known trauma to her legs or back.read more
A 19-year-old female with past medical history of aerophagia, autism, developmental delay, seizure disorder, chronic constipation presented to the ED complaining of abdominal pain. Parents reported 2-3 days of worsening abdominal distention and pain, decreased stooling, and decreased activity. Parents stated that this is the most distended she has ever been. She had prior hospitalizations for aerophagia and distention, and usually decompressed spontaneously or with rectal tube. Her ROS was positive for abdominal pain and nausea, and negative for fever, vomiting, diarrhea, hard stool or blood in the stool. Previous surgeries included myringotomy with bilateral tubes. She lives at home with her parents and is up-to-date on vaccinations. She has multiple food allergies. They are compliant with her home medications.On exam, she appeared ill and acutely distressed. Her vitals were HR 136, BP 139/108, T 37C, RR 16, and Spo2 on room air of 100%. She had dry mucous membranes, and her abdomen was severely distended, tense, tender, and tympanic with hypoactive bowel sounds. Her capillary refill was delayed to 3-4 seconds. Immediate ED Interventions:read more
In November 2020, the US Food and Drug Administration (FDA) provided Emergency Use Authorizations (EUA) for virus-neutralizing monoclonal antibody therapies for the treatment of mild to moderate COVID-19 in high-risk groups of adolescents 12-17 years and adults. Multiple studies have shown that this treatment significantly decreased the risk of subsequent emergency department (ED) visits and hospitalizations in adult patients over 18 years. It has become a game changer in the treatment of adult patients. With the first waves of the pandemic a relatively small proportion of COVID-19 infections occurred in pediatric patients, thereby limiting the experience with monoclonal antibody therapy in patients 12-17 years of age.read more
For anyone interested in a Pediatric Emergency Medicine Fellowship, the ACEP Pediatric Section and AAP held 2 webinars where Program Directors were available to answer questions. You can listen to the webinars here.