Welcome to the Emergency Medicine Cases Podcast. I'm your host, Dr. Anton Hellman, bringing you the brightest minds in emergency medicine from around the world.

EMCases is brought to you by Shremi, the Schwartz-Riesman Emergency Medicine Institute. That's a non-profit organization dedicated to improving EM care through high-quality research and education. The opinions expressed on this podcast are intended for information and education purposes only and should not be used to diagnose treat or prevent any medical condition, nor should they be used as a substitute for medical advice from a qualified practicing physician.

July 16th, 10. The opinions expressed on this podcast are intended for information and education purposes only and should not be used to diagnose treat or prevent any medical condition, nor should they be used as a substitute for medical advice from a qualified practicing physician.

July 16th, 10 a.m. Eastern Standard Time. That's when tickets for the online international EM cases summit go on sale.

The summit's going to be November 21st to 23rd, 2004. This is the best, most interactive, most educational, most rejuvenating

virtual EM conference in the world. Space is limited for the symposiums on ED flow,

rural EM, and global EM. Space is limited for the Hart's ECG course with Jesse McLaren,

and also limited for the small group simulations with Sarah Fooey.

Head on over to EMCases Summit.com to grab your tickets.

Your ticket will include an e-book summarizing the talks, three days access to all the talks and procedural demos,

plus access to all the speakers to ask any clinical questions that you might

have and a chance to connect with EM providers worldwide. Right. Now on to pediatric meningitis.

You hear an overhead call to your ED resuscitation room. As you enter the room, you see a toddler

who looks sick. They're drowsy, pale, and modeled. You look up at

the cardiac monitor and you see a heart rate of 160, respiratory rate of 42, oxygen saturation

of 96% on room air. There's no obvious signs of respiratory distress, and the nurse tells you the temperature is 38.5 degrees Celsius. The mother of the child then tells you that her child has had a cough and cold with a fever for the last four days or so, and just a few hours ago became drowsy, which prompted her to bring them to the emergency

department.

Intake has been poor, a few less wet diapers than usual, no vomiting, normal bowel movements,

no rash.

There's no recent travel history, no sick contacts, no past medical history.

The child's fully immunized. Mom has been giving

the child ibuprofen for fever with pretty good effect. A quick initial physical exam reveals

...