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.
It’s a nice spring day when you get the call from the charge nurse that
there’s a new patient for you to evaluate in the psychiatric area of the
ED. It’s a 14-year-old boy who was brought in by the local police after
he was found trespassing in a neighbor’s yard and collecting a plastic
bagful of “Freon”-type refrigerant gas from their air conditioning unit.
Whenever emergency physicians prescribe drugs for children, the
potential exists to make mistakes. A lot has been written about
medication errors and how to lower your risk of making them.
Intranasal analgesia are fast, effective and easy to administer to children. Are you taking advantage of this delivery option?
You smile as you dispatch the resident to check out a 17-year-old girl
with a chief complaint of migraine headache. Migraines can be so
satisfying to treat... Yeah, you should have known it wasn’t
going to be this straight forward.
With increased use of ultrasound, small bowel intussusception is becoming more frequently recognized. The most important predictor of whether it will need to go the OR is length greater than 3.5 cm.
It’s the day shift and for once the pace is rather mellow in the
Pediatric ED. You’ve had time to check your email, finish a cup of
coffee and do a little teaching with the medical student. The resident
comes down the hall to present his next case. Time to shake off the
inertia and get on with the business at hand.
This phone call certainly gets your attention, even in the middle of a busy shift. It’s a local health department clinic sending you a newborn they think has neonatal herpes. You gear up to see a baby who may be severely ill. You clear out a room, assemble the residents and rapidly review what you know about neonatal herpes virus.
Practical Pediatrics by Amy Levine, MD
Why has this child been intermittently refusing to walk for six weeks?
It’s been another busy night, mostly flu patients but a few other scattered maladies and injuries to keep life interesting. The next case, for instance, doesn’t sound much like flu. The nurse has just put a 15-year-old boy in bed 10 with a complaint of fever and facial swelling. Variety is the spice of life. Off you go to check him out.