W1-RMHow 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 ypeds-90ear 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.

altIt’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.

alt‘‘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.

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