How to narrow down the diagnosis of pediatric leg pain when infections, inflammations, neoplasms and orthopedic conditions all remain on the differential
It’s that time of year again. Every shift, every day, it’s fever, cough, congestion. The hospital infectious disease report confirms that you are in the middle of an influenza epidemic. Tonight has been no different.
It’s about midnight in the Pediatric ED and you enter room 6 to see two exhausted and disheveled parents with a very cranky 14-month old daughter. She has had a cough, congestion, runny nose and low-grade fever for several days and tonight woke up crying and wouldn’t settle down.
It’s night shift and the patient flow has been steady. You sneak off
to the lounge to grab a quick bite to eat and when you come back, you
have not one, but two 6-week-olds with a chief complaint of fever. No
problem, right? Aren’t there protocols for that? Well, yes and no.
‘‘We need you in room 4 right now!” You had been in the back room,
enjoying a sandwich during a break in a relatively quiet shift. With
those words, that quiet (and your sandwich) are over. You sprint down
the hall to see what’s going on.
Fever in the newborn is easy in one respect. You don’t have to think,
just do. If the baby has a fever in the first four weeks of life,
emergency physicians will obtain cultures, start antibiotics and admit.
The lumbar puncture is a standard part of the “sepsis work-up” for
It has been a steady day in the pediatric ED. The volume is beginning to
pick up a little. The resident has just presented the sickest kid of
the day to you. He’s a four-year-old with fever, headache, vomiting and
neck pain. He has nuchal rigidity. He has no rash or focal neurologic
Your next patient has had abdominal pain for a week. The patient’s
parents think it could be related to a recent incident at summer camp.
Could they be correct or are they serving up a red herring?
While acute abdominal pain is a common presenting complaint in emergency
departments, the diagnosis of acute appendicitis can be extremely
difficult in young children, who may not have the classic findings that
are typically seen in older patients.
Business has been brisk in the Pediatric ED today and you’re getting
tired towards the end of your shift. A four-year-old boy with a chief
complaint of pink eye has just shown up, and you’re thankful for the
break. You dispatch the medical student down the hall to check it out.