MDM for different chief complaints (peds)

This page is for pediatric patients. For adult patients, see: MDM for different chief complaints."

Asthma Exacerbation - Mild

_ y/o patient with history of asthma presenting with mild asthma exacerbation. Patient given albuterol, atrovent and steroids. Unlikely pneumothorax or pneumonia given history of asthma, physical exam findings and significant improvement with treatment. On re-assessment patient has normal vital signs without signs of respiratory distress or increased work of breathing. _Patient and parents were given strict ED return precautions and agree with assessment and plan. _Albuterol rx refilled. Will follow-up with PMD in next few days.

Asthma Exacerbation - Severe

_ y/o patient with history of asthma presenting with severe asthma exacerbation. Vitals notable for tachypnea, hypoxia and tachycardia. _Patient was given albuterol, atrovent, steroids and epinephrine. On re-assessment the patient still has significant increased work of breathing and tight breath sounds. _ CXR negative for pneumonia or pneumothorax. Although patient does not require intubation at this time, they will be admitted for continuous albuterol treatment and close monitoring. Parents agree with this plan and all questions were answered.

Allergic Reaction/Anaphylaxis

_ y/o patient presenting with allergic rxn/ anaphylaxis likely due to _. Patient presented with respiratory distress_ urticaria _ and GI symptoms. Patient immediately received epinephrine IM, benadryl IM/ IV, methylprednisolone IV, famotidine IV/PO. After receiving epi pt was tachycardic but that subsided. Patient’s respiratory distress improved after medication. Given sudden onset shortness of breath considered other diagnosis including foreign body aspiration (symmetric breath sounds), asthma exacerbation (unlikely given no hx of asthma and rash as well as rapid onset), and infection (pt not febrile and symptoms improved with anaphylaxis treatment). Will DC home with rx for epi-pen given that they have been symptoms free for at least 4 hours from initial presentation. Instructed to avoid offending agents and to follow up with an allergist for skin testing. _ Patient will be admitted given the severity of their initial presentation and since they _he/she required repeated doses of epinephrine IM or had poor response to initial treatment.

Abdominal Pain (0 - 3 months)

_y/o child presents with abdominal distension +/- vomiting and fevers. Patient has a _normal birthing history, no hx of NICU stay or other complications. Based on labs, abdominal KUB, ultrasound I have low suspicion for necrotizing enterocolitis, pyloric stenosis, volvulus, torsion, toxic megacolon, incarcerated inguinal hernia, constipation or acute gastroenteritis. _Patient was given antipyretic and oral rehydration solution. _Tolerated PO in department. Presentation not consistent with other acute, emergent causes of abdominal pain at this time. Will be discharged home with parents to f/u with their PMD. _ Will be discharged home with parents and return tomorrow for belly recheck.

Abdominal Pain ( 3 months - 3 years)

_ y/o child presenting with abdominal pain +/- vomiting and fevers. Vitals are within normal limits, patient is non-toxic and tolerated PO. Less likely Intussusception given reassuring ultrasound, no hx of bloody stool, no asymptomatic periods between episodes, no lethargy or palpable mass. Meckel’s diverticulum is possible but would be atypical without a reported history of rectal bleeding. Volvulus and malrotation is unlikely given otherwise well-appearing patient without rigid/distended abdomen. I have low suspicion for appendicitis, torsion, HSP (no palpable purpura) and UTI (reassuring UA). Parents were notified that intussusception could potentially still be the source of the pain despite having a reassuring ultrasound on this visit. Should the patient appear to be in pain once again they were told to immediately return to ED again.