Author: Alyssa Cocchiara, DO

Sunday Scaries

Narcan – Sunday Scary

Case: 16yr old female (about 55kg) came in to the ED as toxic ingestion of opiates, stating that she took percocets and hydromorphone pills her parents had in the house. As the team was managing the case, 6 hours into observation they noted that she was becoming increasingly lethargic, they noted she would maintain her ventilation although noted EtCO2 of low-mid 40s (nml 35-45 mm Hg) with two periods of apnea where she would desaturate down to 86%. All labs (including tylenol level taken at 4hr from ingestion) were within normal limits (urine tox opiate and oxycodone

by Alyssa Cocchiara, DO
Sunday Scaries

Ingrown Toenail (Sunday Scary)

Case: 5 yr old girl presents to the ED with toe pain. Mom states she saw that the toe was red and painful and looked like an ingrown toenail. First, this mom is really bad at cutting toenails! after performing this procedure tell patients to not cut nails straight across as it is more likely to grow into the lateral nail fold, to stay away from tight shoes, and address rotated digits or toe deformitiesSecond, if you have a patient with this, start soaking the foot before you sit down to do the procedure, it will make your lifeso much easier! Stage I --> erythema

by Alyssa Cocchiara, DO
Sunday Scaries

PANDAS – Sunday Scary

CASE: 7 yr old female (fully vaccinated) came to the ED with sore throat of 3 days duration, sent from school for vomiting and having a full body tremor. Vitals stable, afebrile. On examination she was tremulous without any focal neuro deficits, able to follow commands and speaking in full sentences (all while continuing to shake).Exam positives included: Tremulous throughout examination with distractability (pausing during finger to nose testing) AND erythematous oropharnyx +tonsilar exudates. Tested Rapid Strep +Okay, so this kid had strep pharyngitis but what is

by Alyssa Cocchiara, DO
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