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 49: Tomás, a 17-Month-Old Boy with Worsening Respiratory Status
"Tomás, a 17-Month-Old Boy with Worsening Respiratory Status", 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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You are working an overnight shift on the pediatric acute care floor in December. During handoff you hear about Tomás, a 17-month-old, otherwise healthy boy who was admitted from the emergency department (ED) earlier in the afternoon with symptoms of rhinorrhea, cough, fever, and decreased urine output. He received 2 normal saline boluses and acetaminophen in the ED and was admitted to the wards where he was started on a nasal cannula at 2 L/min and intravenous (IV) fluids at a maintenance rate. Your colleague mentions that Tomás has some mildly increased work of breathing and tachypnea. The handoff assessment is acute viral bronchiolitis with dehydration.
Halfway into your overnight shift, Tomás’s bedside nurse pages you to report that Tomás is “looking worse” and asks you to evaluate him.