This educational guide provides a much-needed subspeciality-specific learning resource for pediatric hospital medicine. Featuring 50 of the most commonly presenting topics encountered by pediatric hospitalists, this book brings readers into the morning meeting and walks them through patient presentation, diagnosis, treatment, and resolution, providing realistic examples in an engaging case-based format. Available for purchase at https://shop.aap.org/pediatric-hospital-medicine-a-case-based-educational-guide-paperback/
Case 9: Holly, a 5-Year-Old Girl with Fever, Vomiting, and Thigh Swelling
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Published:August 2022
"Holly, a 5-Year-Old Girl with Fever, Vomiting, and Thigh Swelling", Pediatric Hospital Medicine: A Case-Based Educational Guide, American Academy of Pediatrics, Melissa G. Cossey, MD, FAAP, Lauren K. Gambill, MD, MPA, FAAP
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CASE PRESENTATION
Holly is a 5-year-old previously healthy girl who presents to the emergency department (ED) with fever, vomiting, and right thigh swelling. In the ED, she is lethargic (Glasgow Coma Scale [GCS] score: 11), febrile with a temperature of 38.9 °C (102.0 °F), tachycardic with a heart rate of 160 beats/min, and she is noted to have a rash. The ED physician caring for her obtains intravenous (IV) line access, orders a blood culture and laboratory tests, and gives Holly a dose of IV clindamycin for suspected thigh cellulitis. Holly is also given 40 mL/kg of normal saline boluses with subsequent improvement in her tachycardia. After Holly’s stabilization, the ED physician contacts you with a request for admission. Holly arrives to the inpatient unit before you have an opportunity to evaluate her in the ED. Her nurse calls you and asks that you immediately come to her bedside to assess her.
