Solved on Sermo: February 2020 edition

We’re moving healthcare forward, one patient case at a time. Did you know that each year, Sermo physicians work together to solve over 8,000 patient cases through the power of crowdsourcing? Here’s two recent cases solved on Sermo, and be sure to check back soon for more!

Case 1: Facial trauma

5-year-old male patient who after bicycle fall and slip on the pavement presents wounds on the face for which he is brought 1 hour later to the emergency, father denies loss of consciousness, vomiting and seizures, to the patient-oriented physical examination in time, space and person, Glasgow 14/15 points, isochoric and normal reactive pupils in the light, multiple friction-type lesions, bi-palpebral edema are evident on the face, complementary tests are performed where the only thing that attracts attention is a moderate cerebral edema at skull CT level, at 2 hours the patient is reassessed who begins to present alternating Glasgow from 12 to 14 and finally presents Glasgow with 8 points whereby incubation of the patient is performed and go to the intensive care unit. 

What would be your recommendation? 

Total time until solved: 5 Days 

Total Comments: 23 

Poll Results: “Would you repeat the CT scan of the skull at the time it was decided to intubate the patient?” 

87% of doctors voted, Yes. 

Member comment example:

Sermo Pediatric Endocrinologist: After intubation, he must be stabilized in the ICU and once the cerebral edema is controlled, the neurosurgeon will decide the appropriate time to repeat this study.

Case 2: 16 year old with joint pain

This is a 16-year-old male adolescent, who’s illness began on 12-15-2019. Characterized by joint pain, of moderate intensity, specifically in ankles, symmetrical, which partially reduces with Ibuprofen, limiting the extension and flexion of the feet and gait; combined grade II edema, deformation of the left ankle joint. Reason for which they visited 12-31-2019 for assessment and conduct. 

Personal Pathological Background: 

  • Hospitalized at age 14 (for approximately 20 days) due to edema in the lower limbs. They do not define what the diagnosis was. 
  • Rest: Denies surgeries, injuries, allergies 

Upon lower extremities examination: Bilateral Grade II Edema is evident. Deformation of the ankle joint, with protuberance in the supracalcaneal region, of petrea consistency, painful on palpation and slight heat. 

Total time till solved: 1 Day 

Total Comments: 32 

Diagnosis: Juvenile Idiopathic Arthritis (JIA)  

Member Comment Example: 

Sermo Urologist: Rheumatology assessment is mandatory in this case in order to specify JIA chart. You must also have cardiological assessment.