8 month old with vomiting

[pbruss]

8 month old with ITP being treated by heme-onc comes in with 6 hours history of "projectile vomiting" its 6 am so the kid is sleepy but arousable, not lethargic for the time of day per mom and mom is reliable and smart, overall non-tosic in apearance. mom states she has episodes where "she cires a lot and jerkes her right arm". vitals all with in normal limits. exam- increased cap refill, pale with diffuse purpuric rash (which is normal and unchanged per mom) all other findings are all with in normal limits. platelet count is 14 and Hg is 14 (drawn yesterday by heme-onc). what is your next step?

[kemple]

ct brain w plt of 14 have to r/o bleed as reason for the seizures which is what those jerky movements sound like. With projectile vomiting I'm worried about increased ICP.

[Bjs04f]

good first step r/o major complication. Secondly is this kid on long term steroids. If dan is right ignor my question about and adrenal suppresion follow up

[pbruss]

spot on here is her ct

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[tyson]

i think hackman had this case in the picu. he may be able to add some follow up etc....