Emergency Medicine Cases EM Quick Hits 69 Pediatric Urinary Retention & Acute Transverse Myelitis, Post-Dural Puncture Headache, Med Mal Cases: Clenched Fist Injury, IV Thrombolysis for Minor Stroke, EM Leadership Spotlight #4
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Dec 2, 2025 In this insightful discussion, Deborah Schoenfeld, a pediatric emergency medicine educator, dives into the complexities of pediatric urinary retention and acute transverse myelitis, outlining key diagnostic strategies. Matthew McArthur, an expert in headache management, reviews the nuances of post-dural puncture headaches, emphasizing prevention and treatment. Joseph Yasmeh presents a compelling medico-legal analysis of clenched fist injuries, detailing common pitfalls in management. Brit Long tackles the controversial use of IV thrombolysis for minor strokes, while Lauren Westaffer shares invaluable mentorship and leadership strategies for emerging physicians.
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Transverse Myelitis Can Present With Urinary Retention
- Acute transverse myelitis is a focal inflammatory demyelinating spinal cord process causing motor, sensory, and autonomic dysfunction below the lesion.
- Urinary retention can be the first sign and mandates consideration of spinal pathology, especially in adolescents.
Quick Pediatric Bladder Capacity Formula
- Calculate expected pediatric bladder capacity: (age + 2) ounces, multiply by 30 for mL to assess retention.
- Use bladder scan or palpation and this formula before diagnosing urinary retention.
Structure The Pediatric Retention Differential
- When evaluating pediatric urinary retention, group causes into infectious/inflammatory, obstructive, neurogenic, and functional categories.
- Inspect local genital causes, urethral obstruction, pelvic masses, and neuro causes before labeling behavioral retention.
