When we see infants with bronchiolitis, identifying the sick ones is pretty easy. But what we actually want to do is identify which patients are going to deteriorate, which patients we need to admit, and which patients we need to observe for a bit longer in the Emergency Department.

Here are my top five tips on how to manage bronchiolitis.

A 62-year-old female with a history of diabetes and end stage renal disease (ESRD) on dialysis presents to the Emergency Department with chief complaint of shortness of breath, malaise and subjective fevers. The patient reports progressive shortness of breath with dyspnea on exertion over one month with malaise over the same duration and fevers in past 2 days. Additional symptoms include anorexia, myalgias, headache and chills. The patient denies cough, recent travel or known sick contacts. She is febrile, tachycardic, and mildly hypoxic and in mild respiratory distress. She has poor dentition and an audible cardiac murmur. The rest of her examination is non-focal.

What should you consider in the differential diagnosis and what are the next steps to evaluate and treat this patient?

Period problems in teens are common. They can cause significant disruption and distress to adolescents and their parents but rarely have a significant or medically worrying underlying cause. In this series of articles, I’ll try to provide a logical and systematic approach to assessing and managing period problems in teenagers (recognizing that this may often be able to be extrapolated to adults too for those of you who do not only see children).

22 y/o M no pmh p/w painless jaundice x 5 days in the setting of recent febrile illness 1 week prior and taking Tylenol 1g q6h for several days.

Physical exam was positive for jaundice, otherwise normal.

Notable lab findings include:
HepA IgM positive
Elevated LFTs with ALT in 1400s
Coags normal
APAP level negative
VBG/BMP normal
US RUQ normal

The patient was ultimately determined to be in Stage IV APAP toxicity and happened to have labs from the day before. When the labs were trended, it was adequate to make the determination that the ALT had already peaked.

A 35-year-old female with a recent diagnosis of sinusitis presents with worsening headache, eye pain, nausea, and double vision for 3 days. Her symptoms started with facial pain and nasal congestion approximately 1 week ago. She has a history of diabetes type II on metformin. Exam reveals BP 118/55, HR 108, RR 17, T 37.2 C. Exam reveals difficulty looking laterally with the left eye. Her visual acuity is normal, and her strength and sensation are also normal.