This educational guide provides a much-needed subspeciality-specific learning resource for pediatric hospital medicine. Featuring 50 of the most commonly presenting topics encountered by pediatric hospitalists, this book brings readers into the morning meeting and walks them through patient presentation, diagnosis, treatment, and resolution, providing realistic examples in an engaging case-based format. Available for purchase at https://shop.aap.org/pediatric-hospital-medicine-a-case-based-educational-guide-paperback/
Case 48: Aria, a 16-Year-Old Girl with Headache and Confusion
"Aria, a 16-Year-Old Girl with Headache and Confusion", Pediatric Hospital Medicine: A Case-Based Educational Guide, American Academy of Pediatrics, Melissa G. Cossey, MD, FAAP, Lauren K. Gambill, MD, MPA, FAAP
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A 16-year-old previously healthy girl, Aria, presents to the emergency department (ED) with headache and confusion. While in triage, Aria has 2 episodes of emesis and several staring episodes. While being transported to a room, she has 20 seconds of convulsive movements that self-resolve, after which she is confused, sleepy, and does not recognize her parents. The ED physician obtains initial laboratory studies including a complete blood cell count (CBC) with differential, comprehensive metabolic panel, C-reactive protein (CRP) level, procalcitonin level, coagulation studies, urinalysis, urine drug screen, and pregnancy test. All of these studies are unremarkable. A blood culture is pending. A computed tomography (CT) scan of the head is performed, and the preliminary read is negative for any acute intracranial pathology. The ED physician gives Aria a dose each of acetaminophen and ondansetron, and due to concern for seizures, the physician also gives her a loading dose of levetiracetam. She also starts Aria on a continuous electroencephalogram (EEG). In the intervening 2 hours, Aria has not returned to her baseline neurologic status. The ED physician calls you to request admission for further evaluation and monitoring.