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Information initially provided to participating teams:

Ex-term now 4 week 5 day old baby born at home now with a fever (rectal temp 38.9 C) tactile fever at home and a cough, mom brings the baby to the ER and the baby has not been eating and drinking well for the past 1.5 2 days. MGM and 5 3 y/o sister sick (sister in pre-school). She doesn't have a thermometer so she doesn't know what his temperature has been. 

 

Initial clinical signs:

Vital signs:  HR 190 (normal range 120-140),  70 (normal range 30-50), 55/30 (SBP 60-100), Temp 38.8 C

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cap refill 4 seconds

 

PMH:  term, NSVD, maternal labs negative, no  pregnancy or birth complications, home with mom no NICU stayno prenatal care, 8 lbs (3.6 kg), no known PMH, PSH, meds or allergies. Has not had any vaccinations or blood work done, never seen by a doctor, lives with parents and 3 y/o sister and 5 y/o brother. 

 

ROS:

started 2 days ago with congestion and runny nose, has been taking less milk, exclusively breastfed

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SH: lives at home with Parents, MGM and 5 y/o sister sick (sister in pre-school)

 

Exam:

Vitals taken while baby is lying quietly in mom's arms

HR 190; BP 68/41; RR 45; Temp 102 F rectal, O2 sat 99% on room air 

HEENT: sunken fontanel

CNS: listless, moving all extremities when provoked, intact sucking reflex

cardio: tachycardia, poor peripheral perfusion, capillary refill 4 seconds, equal brachial and femoral pulses

respiratory: mild subcostal retractions, clear bilaterally

GI: wnl

GU: noncircumcised penis; wnl

skin: cool extremities, dry, intact, no rashes or ecchymosis

patient vocal sounds: not vocalizing

 

Proposed treatment:

Wash hands

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Information initially provided to participating teams:

7 4 yo boy with a past h/o wheezing brought to the ED by ambulance.  He has had a cough and runny nose for 2 days and this morning awoke in respiratory distress and struggling to breathe.  He is unable to speak in full sentences.  Mom is very anxious. EMS has started an IV and started NS at a keep open rate

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Differential diagnosis for wheezing

 

Resources

Pedi Stat (app available on phone  available for 2.99) https://itunes.apple.com/us/app/pedi-stat/id327963391?mt=8