Pediatric M&M - Dr. Neal

16 yo with syncope

16 yo who passed out on airplane with lots of social stressors.

• Keep your differential broad - avoid premature closure and don't get complacent just because the patient is a child.
• Despite the patient's many social stressors and apparent anxiety, she still had a large Pulmonary Embolism.
• PE in Kids

1. Very rare, but still occurs
2. Pursue risk factors
3. Symptoms are often the same as in adults
   
4. Central venous cath was highest risk factor in one study

• Syncope as presenting symptom of PE
  

1. Associated with more severe disease.
2. More likely to have right heart strain.

• A combination of biochemical markers, imaging, EKG, echo, hemodynamics should factor into patients trajectory and decision for lytics.
• Indications for lytics in kids are only for 'life or limb saving' conditions.

13 yo with abdominal pain

"Chronic" abdominal pain over past 2-3 months.

• Be aware of diagnostic momentum.....
• For persistent abdominal pain, make sure that you consider conditions that are "outside" the abdomen.
• Always, reconsider Pregnancy!
• Always reconsider your diagnosis, particularly when the family is being "difficult."
  
• Rhabdomyosarcoma

1. Most common soft tissue tumor in children
2. They are very difficult to diagnose!

• Red Flags

1. Pain that awakens at night
2. Extremity dysfunction
3. Prolonged pain
4. Unusual fracture.