Yes, this is E.MK's best case ever mini podcast series, and I'm your host, Dr. Anton Hellman.

For this best case ever, it's my pleasure and honor to introduce Dr. Gary Joubert, a pediatric emergency physician who also has training in pediatric

cardiology to give us his best case ever. Dr. Joubert, welcome to EM cases and let's hear your

best case ever. Well, thank Anton for that very generous introduction.

And having a dual role in emergency medicine and cardiology over most of my career

has been really quite a pleasure to see some unusual circumstances.

And I'm going to reflect back on a case that occurred early in my career.

It was a four-month-old female who presented

to the emergency department. I had been thriving. When they presented a triage, the mother's

presented a complaint was, my baby looks blue in the lips at times. And of course, we've all heard

that as an emerged physician. And of course, we started thinking of our broad differential associated with being glued

but when the vital signs were done the sats were actually 98%. The heart rate was in about the 140 range.

Respiratory rate was a very nice 30 and not in any way using extra effort in terms of work of breathing.

So the child was brought in and was introduced in the waiting and waited for a couple of hours.

Finally, a medical student went to see the child, which is always the case, and went on and brought back this beautiful history.

And of course, you know, in that scholarly way we like to do as academic emerged physicians, we said, okay, well, give me your differential diagnosis. And, you know, they started off, well, you know, this could just be normal physiology, you know, sometimes when babies are feeding or something like that. There was really no correlation to feeding or anything else. But he said, could it be related to the fact that, you know, sometimes bail with a pale skin looks a little bit blue around the lips? I said, okay, did mom give you a history? Was it central psionosis? Or was it just, you know, some perioral psinoces or was peripheral? Oh, I didn't ask. Okay, well, we've got to go check that out. We'll go back and do that. The baby, you know, ever have difficulty feeding or look diaphrodite during feeding? Oh, no, no, no.

So his differential went on and, of course, you know, he started to talk about Gerd because we know sometimes GERD can make babies look like that. He talked about the fact that, you know, maybe this was congenital heart disease, but really didn't look at it. and maybe just the mother was imagining things because we always like to blame mothers.

In fact, when you went back and had a discussion with the mother about what the family physician had said, and this is not

to put our family physician colleagues down, but they thought first time mother a little bit hyper,

over-examining her child. Went and examine this child, and to be quite honest, the physical examination

was extremely unremarkable, But just by chance, during the physical

examination with a child hooked to an oxymeter, their stats dropped to 88%. And of course, we looked

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