Case presentation A 10-year-old male presents with 2 days of initially intermittent, now constant, abdominal pain. He states that the pain started on the right side of his abdomen and was crampy in quality, although now has become more sharp. The pain has now localized to the right lower quadrant, although he complains of radiation to the umbilicus and the right upper quadrant. He has not…
Case presentation A 15-month-old boy is brought into the emergency department by his parents for inconsolable crying for the last 6 hours. He has been crying and refusing to feed and has had nonbloody, nonbilious emesis twice. He is afebrile and his other vital signs are heart rate in the 160s beats per minute, respiratory rate of 30 breaths per minute, blood pressure of 107/89 mm…
Case presentation A 2-year-old male with a medical history of Hirschsprung disease requiring colectomy and ileo-anal pullthrough presents with multiple episodes of nonbilious emesis and no stool output over the past 24 hours. The mother states that she has noted that the child has had increased abdominal girth over the past 48 hours and has become fussy. He has had decreased oral intake. There has been…
Case presentation A 7-month-old male with a history of prematurity (27 weeks’ gestation) presents with a gastrostomy button that fell out approximately 3 hours prior to arrival. The child has had the gastrostomy button for 3 months. The mother tells you that the button “slipped out” during the child’s feeding. She attempted to replace the button but was unsuccessful. The child was seen at an outside…
Case presentation A 2-year-old female presents to the emergency department with wheezing and cough. The family states that she has had mild fever to 100.1 degrees Fahrenheit for the past 2 days. There has been no vomiting or diarrhea. She has been taking oral fluids well and is otherwise behaving at her baseline. Her physical examination reveals a well-appearing child in no respiratory distress. She has…
Case presentation A 7-week-old male presents with difficulty breathing while feeding for 1 day. The child is formula fed 3 ounces every 3–4 hours, but over the past 2–3 days, he has been feeding every 4 hours and not completing the 3 ounces. One day ago, he developed increased work of breathing while feeding and “turned pale for several seconds” according to the parents. There was…
Case presentation A 13-year-old male presents to the emergency department (ED) with 2 weeks of chest pain. He describes the pain as sharp and constant, worsening over the past week. Two weeks ago, the patient had fever to 102 degrees Fahrenheit and cough. He then developed sharp frontal chest pain that he described as “stabbing.” The pain worsened when lying down. He was seen by his…
Case presentation A 10-day-old infant presents to the emergency department with 1 day of fussiness, decreased oral intake, decreased urine output, and three grossly bloody stools. There has been no fever, cough, congestion, vomiting, or rash. The child is breastfed exclusively and the mother denies she has had cracked nipples or bleeding from the breast. She has noted the child is feeding less vigorously today. The…
Case presentation A 2-day-old patient is referred to the emergency department for failure to pass meconium. He was born at home and had prenatal care, although this was not consistent, as the mother had missed some of her appointments. The delivery was at term (38 weeks gestation), vaginal, and apparently uncomplicated. The infant was vigorous and did not require resuscitation other than standard drying and stimulation.…
Case presentation A 12-hour-old infant presents “looking blue” and with poor feeding per the mother. The child was delivered at home and the mother had no prenatal care. She describes her pregnancy as uneventful. The physical examination reveals an overall well-appearing infant who is afebrile. There is a heart rate of 150 beats per minute, a respiratory rate of 60 breaths per minute, a blood pressure…
Case presentation A 4-day-old patient presents to the emergency department with forceful emesis associated with every feed. The emesis is described as nonbloody, slightly green in color. The child has decreased feeding and activity over the past 24 hours. There has been no fever, diarrhea, cough, or congestion. There is no report of trauma. The child was the product of an uncomplicated term spontaneous vaginal delivery…
Case presentation A 5-day-old male infant presents with decreased feeding and activity for the past 24 hours. The parents report emesis that initially looked like infant formula but over the past 12 hours has become “yellow-green” and the last several episodes have been “green.” The emesis has occurred whenever the child attempts to feed, which was typically every 3 hours, but the parents have been attempting…
Case presentation A 6-month-old baby with cough, congestion, and fever for 3 days presents to the emergency department with complaints of respiratory distress. Physical examination is significant for a temperature of 102 degrees Fahrenheit, respiratory rate of 55 breaths per minute, pulse oxygen saturation of 92%, and prominent intercostal, subcostal, and suprasternal retractions. On auscultation, there are diffuse crackles and intermittent wheezing heard in all lung…
Case presentation An 8-month-old male presents with 2 months of cough and intermittent rhinorrhea. He has been seen multiple times by his primary care provider and has been diagnosed at various times with viral upper respiratory tract infection and acute otitis media, for which he has been prescribed oral antibiotics. He has had some intermittent fevers as well, all of which have resolved after several days.…
Most pediatric imaging procedures do not require sedation. There are patients, though, who will require some level of sedation in order to obtain a meaningful imaging study. The reasons for sedation are many but include anxiety, painful condition (such as fracture), age of the child (younger children tend to be less cooperative), or study length. Lengthy studies (e.g., extensive magnetic resonance imaging of the brain or…
Exposure to ionizing radiation Exposure to ionizing radiation is a natural consequence of living on Earth. We are exposed to ionizing radiation from the Earth beneath our feet, from the air we breathe, from materials within our own bodies, and from space. Background radiation from natural sources varies by location and is generally greater at higher elevations. For a person in the United States, the estimated…
To image or not to image? Quality in health care, as defined by the U.S. Agency for Healthcare Research and Quality, is “doing the right thing for the right patient, at the right time, in the right way to achieve the best possible results.” When a pediatric patient presents in the emergency setting, the decision of which, if any, imaging test should be performed can be…
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