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.
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?