PEMPix is the American Academy of Pediatrics Section on Emergency Medicine’s visual diagnosis competition. It is held annually at the National Conference and Exhibition. This year, all ten finalists will be posted online on PEMBlog.com and at PEMPix.com, one a day with voting opening to AAP Section on Emergency Medicine members thereafter. I hope you enjoy this online-only format, and hope that it will serve to highlight some of the fantastic learning cases that our colleagues submitted this year. It was again very difficult for the panel of judges to select the finalists and I could not have done it without their assistance. As a special treat I’ve included a musical selection form the 1980s as an optional “hint,” and to serve as a soundtrack for your learning.
This PEMPix case was submitted by:
Kasi Eastep, DO, Pediatric Emergency Medicine Fellow along with Michelle Stevenson, MD and Danielle Graff, MD, MSc from Norton Children’s / The University of Louisville School of Medicine
Blown away
A 10-year-old female presented to the emergency department with a one-week history of cough, fever and malaise. Five days prior, she had been seen at another facility where a rapid influenza screen was reportedly positive. Sick contacts had included multiple family members. Her symptoms worsened and included swelling of the neck and face, sore throat, nonproductive cough, as well as pain and numbness of the left arm. Upon arrival to the Emergency Department, she was placed on a nonrebreather mask for respiratory distress and hypoxemia. She was tachycardic to 134 beats/minute. Her physical exam was significant for trismus, neck rigidity, and submandibular swelling – left greater than right. Lung aeration was diminished bilaterally without wheezing, rales, or rhonchi. Her left arm was tender to light palpation and demonstrated 4/5 strength throughout when compared to the right.
- Rapid Strep: positive
- Respiratory Pathogen Panel: positive for influenza A
- CRP: 18.6 mg/dL
- ESR: 22 mm/hr
- Urinalysis: 10 protein, 20 ketones, small blood (1 RBC), trace bacteria
- Venous blood gas, CBC, Complete Metabolic Panel, and Monospot were obtained and unremarkable