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HA & Fever then CP

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A 12-year-old female presents to the ED for 3 days of fever and generalized headache without vomiting, neck stiffness, or photophobia.  Family brought her in today for ongoing fever up to 102.0 and midsternal nonradiating, nonexertional, nonpleuritic chest pain. She denies any cough, shortness of breath, sore throat or other complaints.

Vital Signs & Physical Exam:

Vital signs are normal except for temperature of 99.3.  Physical exam is otherwise normal including no tachycardia or edema

Initial Differential Diagnosis:

  • Influenza
  • Bronchitis,
  • Viral syndrome
  • Pleuritis
  • Myocarditis
  • Syphilis, the great imitator

Initial Diagnostic Testing:

  • CBC: normal except for 77% PMN’s
  • Chem 7: normal except for
  • Imaging: CXR & EKG normal

QUESTIONS:

  1. Any other labs you would suggest doing?
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. Other Labs: ESR 42, Troponin 8.3, flu negative
  2. What should you do next?  Admit for observation, echo and cardiology consult
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

CLICK HERE TO LEAR MORE ABOUT THIS BOOK

CASE CONCLUSION: We’ll just have to see

CASE LESSONS:

  1. Never
  2. Always
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