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#ir #peds
Infant
Case 2: A 5-month-old male presented
with fever and fussiness. The patient
was seen fi ve days earlier with fever and
URI, diagnosed with otitis media and
discharged home with amoxicillin. Prior to
arrival, the patient had multiple episodes
of vomiting and decreased urine output.
Initial assessment revealed an illappearing,
febrile infant. While observing
the infant and beginning the physical
exam, it is important to place your hand on
the infant’s head and assess the fontanelle.
A fontanelle is measured as full, fl at, or
depressed. Cup your palm on the back of
the baby’s head and then move forward.
The curve of your palm should touch the
fontanelle if it is normal. If the fontanelle
doesn’t touch, it is depressed; if it pushes
your hand up, it is full.
In young infants, a bulging fontanelle may
be seen with meningitis, but meningismus
is rare before one year of age. Another
possible exam fi nding in infants with
meningitis is a paradoxical response
to consoling maneuvers like cuddling.
When a caregiver “cuddles” an infant,
the meninges are stretched and irritated
making the infant more fussy. By contrast,
the same infant will calm when laid fl at.
This infant’s fontanelle was full and
tense. Throughout the exam, the patient
was irritable and diffi cult to console. The
infant was appropriately resuscitated and
underwent a full septic work-up, revealing
pneumococcal meningitis.
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Tricking Kids into the Perfect Exam: Tips for Evaluating the Pediatric Patient
king for rashes, bruises, hair tourniquets, etc. During the exam, this newborn was observed to have an apneic episode. The patient was admitted for an evaluation that ultimately revealed a diagnosis of pertussis. <span>Infant Case 2: A 5-month-old male presented with fever and fussiness. The patient was seen fi ve days earlier with fever and URI, diagnosed with otitis media and discharged home with amoxicillin. Prior to arrival, the patient had multiple episodes of vomiting and decreased urine output. Initial assessment revealed an illappearing, febrile infant. While observing the infant and beginning the physical exam, it is important to place your hand on the infant’s head and assess the fontanelle. A fontanelle is measured as full, fl at, or depressed. Cup your palm on the back of Rose House, MD EM/Pediatrics Resident Indiana University Indianapolis, IN “In general, when evaluating any child, observation is the best initial diagnostic tool.” 34 EMResident the baby’s head and then move forward. The curve of your palm should touch the fontanelle if it is normal. If the fontanelle doesn’t touch, it is depressed; if it pushes your hand up, it is full. In young infants, a bulging fontanelle may be seen with meningitis, but meningismus is rare before one year of age. Another possible exam fi nding in infants with meningitis is a paradoxical response to consoling maneuvers like cuddling. When a caregiver “cuddles” an infant, the meninges are stretched and irritated making the infant more fussy. By contrast, the same infant will calm when laid fl at. This infant’s fontanelle was full and tense. Throughout the exam, the patient was irritable and diffi cult to console. The infant was appropriately resuscitated and underwent a full septic work-up, revealing pneumococcal meningitis. Toddler Case 3: An 18-month-old male presents with complaint of seizure witnessed at home 20 minutes prior to arrival. Many pediatric patients will present to&#


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