Solved on Sermo

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Sometimes, the doctor doesn’t know best – the global medical community does!

Whether a physician is at their clinic or on the road, the SERMO community is on call to help 24/7/365. Physicians come to Sermo to tap into the power of medical crowdsourcing, including second opinions, confirming or ruling out a diagnosis, or collecting feedback on treatment options. In fact, about 8,000 challenging cases are solved through medical crowdsourcing each year on SERMO. To celebrate, we’re kicking off a “Solved on SERMO” blog series where we’ll share notable cases. You can also follow along with #SolvedOnSERMO to find out what other patient cases our network is helping to solve.

Case #1: How Would You Treat a 15 Year-Old with Gaming Disorder?
Case Overview: Paul is 15 years-old and loves playing computer games (mostly Fortnite) on his computer/TV in the bedroom and his mobile phone. He spends 6 hours playing in the evening on school nights and 9+ hours on Fri & Sat nights, often sleeping at 2 am. “He never goes outside” says his mother. “All my friends are doing the same” says Paul. His grades are slipping at school. He does no chores at home, play any extracurricular sports or has a part-time job. He easily becomes anxious at the thought of no internet access, which was proven after he was ‘grounded’ for two days and developed symptoms of ‘withdrawal’ and anxiety (angry, sweaty, distressed, could not focus except for going back online, poor appetite and sleep, etc).

  • # Comments: 110+
  • A few highlights:

“Work on redirecting to things more educational on the computer. Things that actually might help him earn a living at his passion. Coding classes so he can learn how to write code to create his own games. Digital computer graphics classes. Channel that energy into useful computer things for him. Plus make him complete his class work PRIOR to computer free time.”

“Limitations in all aspects of a kid’s upbringing is important. They enjoy eating sugar, but most of us try to limit that. Most of us were taught to limit kid’s TV time. But now that gaming is available on phones, tablets, computers, all of which are commonly in the kid’s control, in their own room, it’s much harder for many parents to limit this. Vigilance and an invasion of their privacy is often needed.”

Crowdsourced treatment recommendations:

  • #1: Psychotherapy (38%)
  • #2: Parents need to better manage his behavior (24%)
  • #3: Enroll in a sport/youth group (20%)

Solved within 21 hours

Case #2: Toddler Fever Not Responding to OTC
Case Overview: So asking as a dad for my 3 yo boy 35 lbs. not my specialty so please bear with me. Has had fever for about 24 hrs, peak 104.2, after taking around the clock Tylenol 160mg and Ibuprofen 100mg, lowers to about 101.9 1-2 hrs after meds. Never dips below that. He’s taking Tylenol/Ibuprofen alternating every 4 hrs, shorter interval.

Other significant finding which could be a red herring is significant periorbital swelling in one eye, lasted about 8 hrs and now resolved. Not painful, not itchy, might have been irritated by rubbing, sclera not injected. Associated with a barking nonproductive cough, tonsils enlarged, ears look clear (not good at it cuz there was a ton of cerumen). Chest sounds clear. No notable Lymphadenopathy. Kid looks fatigued but not toxic. Eating and peeing.

Typically I’d wait 2-3 days then if not better take him into peds, but considering taking him to urgent care soon because am concerned about the fever not really responding to meds (should I be???) Question is, what should I ask or look out for? Test for strep, flu? Am I being a dumdum for worrying? Sounds viral so no meds?

  • # Comments: 30
  • A few highlights:

Treat the child, not the fever. He’s drinking and peeing, not toxic, and has a cough consistent with croup. Humidity, antipyretics/analgesics for pain or if fever is bothering him. Expect peak symptoms during the first 3-5 days, with gradual resolution over a couple weeks. If not improving or if fever greater than 5 days, or if he’s getting worse, then call his pediatrician.”

Ibuprofen dose is 10mg/kg/dose so for his weight you could do 150mg per dose – every 6 hrs. Tylenol is up to 15mg/kg/dose so 225 mg every 4 hrs. You might be underdosing him.”

Solved within 4 hours

Outcome: child had the flu

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