A 3 year-old male presents to the pediatric emergency department with leg pain. Prior to arrival, the patient had been at daycare and was found crying, reporting pain to his right leg. The daycare staff denied any specific trauma and noted that he had been playing happily throughout the morning. His parents were understandably concerned and dad reported that this had been his fourth visit to the emergency department for fractures since he started walking at 12 months of age…
Read MoreIf your hospital system is like mine, it has a dedicated pediatric emergency department. A place connected to a larger children’s hospital, where all of the providers, including nurses are certified in pediatrics. They also offer a whole host of other pediatric support, like child life specialists, without whom I would not be able to suture a laceration or obtain cerebrospinal fluids samples. All of the people have one goal, the safety and well-being of the child. This system, as you might expect, fosters a unique culture of medicine; a culture which I assert is heavily steeped in paternalism…
Read MoreA 14-year-old male presents with right thigh redness and pain. It’s a busy afternoon and you think to yourself, “This will be a quick and easy disposition. The patient probably has cellulitis.” He reports one week of worsening erythema and pain to his right anterior groin. Last evening, he was able to drain a small amount of white to green-tinged material from a small “pimple” that had formed along the medial aspect of his thigh…
Read MoreA 7 year-old previously healthy male presents to the pediatric emergency department following a bicycle accident. The child was struck by an oncoming sedan traveling at approximately 20 miles per hour, causing him to fall off the bike onto his right side. There was no head strike or loss of consciousness. On arrival, the child is phonating, has intact peripheral pulses, and a Glascow Coma Scale of 15. He is noted to be dyspneic, with absent breath sounds on the right. You prepare to place a chest tube with supervision from your attending. This is your first time placing a chest tube. His mother requests to stay in the room for the procedure…
Read MoreAn 11 year-old female presents with approximately 2 weeks of bilateral lower extremity pain that is localized to her knees and calves. The pain is worse with ambulation and not relieved with ibuprofen. She has difficulty ascending the stairs at school and recently started having trouble walking on flat ground. The patient also endorses neck, back, and shoulder pain that are less severe. She recalls an illness associated with vomiting and diarrhea that started approximately 1 week ago, which has still not resolved…
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