‘‘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 neonates.

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 signs.

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.

The resident comes to tell you that you have a transfer request holding on the phone. An outside ED physician has a child with left arm weakness. He feels that the child needs to see the Pediatric Neurologist at your institution. You agree to the transfer and await events.

One steady source of business in the emergency department comes from a group described as the “worried well.” Anxious new parents are frequent members of this tribe and come into the ED at all hours to point out perceived abnormalities or areas of concern in their little ones.

This past September, the American Academy of Pediatrics (AAP) published its new clinical practice guidelines for the diagnosis and management of initial Urinary Tract Infections (UTI) in febrile infants and children. The last guideline for UTIs was published in 1999. What’s in the new guidelines that Emergency Physicians should know about?

Business has been steady in the pediatric emergency department this afternoon. You’ve seen a wide range of cases today, which has been fortuitous as you have a medical student shadowing you who wants to “learn the ropes.” The nurses put a new patient in bed 2. You couldn’t ask for a better, basic teaching case. It’s a 4-month-old male with a fever.