Professor’s Pearls
Section VII: The Emergency Department
1 You are evaluating a 3-week-old in the emergency department (ED) because of inconsolable crying. The newborn has had no fever and if anything appears to be pacified by more feeding. His young mother believes he has “belly pain” because he is drawing his legs up. He was a product of 34 weeks of gestation. His mother reported that labor and delivery were uncomplicated. The newborn has regained his birth weight and is thriving well. His vital signs are rectal temperature, 37.5° C (99.5° F); heart rate (HR), 160 beats per minute; respiratory rate (RR), 44 breaths per minute. Examination reveals a crying, difficult-to-console newborn, but good color, strong muscle tone, and lustrous cry. What is the differential diagnosis?
2 You are presented with a 2-year-old with sudden onset of fever and rash. The child has had chills and appeared ill. The family reports no known sick contacts. You can confirm that all her immunizations are up to date as you review her electronic medical record. Her presenting vital signs were temperature, 39° C (102.2° F); HR, 150 beats per minute; RR, 24 breaths per minute; blood pressure (BP), 76/44 mm Hg. She is lethargic and has a diffuse nonblanching rash. Her neck is supple. Her extremities are warm. The remainder of her examination is nonrevealing. The supervising physician ordered a blood count, for which results are typically received in 2 hours, and the physician is waiting for the results before proceeding to the next step in the management! What is your interpretation of this presentation? What is the significance of the vital signs? Would you approach this patient differently?
3 A 7-year-old child presents to the ED with a 4-day history of sore throat and fever. His mother noticed a lump in left side of his neck. What are the seven elements a clinician must comment on when describing a lump?
4 A 10-month-old has a 3-day history of fever and numerous bouts of vomiting and diarrhea. The stools are very watery and voluminous. The infant is becoming progressively more lethargic. How do you assess the hydration status of this patient? What are the appropriate interventions?
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