Robert L. Quillin, MD, FAAP

Disclosures

Speaker and consultant for VayaPharma, makers of Vayarin

Previous research support provided by PernixTherapeutics

Presentation Outline

Emergencies in the outpatient clinic setting

Making “quick look” assessments

Triage, treat or transfer approach to the sick patient

Office staff and practical management of patient

Parent/caregiver in the treatment plan

This is an emergency . . .

This is sNOT!

Fever

Cough

Vomiting

Stomach and abdominal

pain

Skin rash

Earaches

Sore throat

Injury, head, neck or face

Headache

Facial laceration

Somewhere in between

National Hospital Ambulatory Medical Care Survey:

2010 Emergency Department Summary Tables

What are we talking about then?

Asthma

Fracture

Appendicitis

Seizure

Anaphylaxis

Concussion

Rash

Laceration

Cancer

Definitions

What providers perceive

“to become aware of, to know, or identify by means of the senses”

What parents believe

“to have confidence in the truth, the existence, or the reliability of something, although without absolute proof that one is right in doing so”

What grandmothers know

“to perceive or understand as fact or truth; to apprehend clearly and with certainty”

Behind door number 1 . . .

Check pulse

Call 911

Remember ABC’s

Direct staff, reassure parents

Make a decision

Triage, Treat, or Transfer

Know limits of parents

Know limitations of staff

Know your own limitations

Know your hospital/ER limitations

Case #1: Fever

6mo fever to 104 over last two days. No sick contacts, no daycare, vaccines UTD

VS: T 101.2

PE: Feeding on bottle, PE wnl

Labs: CBC with WBC 18.7, 57%G, UA not collected

Triage, treat and/or transfer?PEARL: DON’T FORGET THE UA

Case #2: Fall

4mo unrestrained rolls out of carrier from counter to tile floor

VS: T 98.2, P 120

PE: Being held by father, smiling, looking around

Crepitus R parietal skull

Labs/image: None, CT Head

Triage, treat and/or transfer?

PEARL: BUCKLE UP!

Case #3: Wheezing

7yo with known h/o wheezing, fever 101. Had RSV as infant.

VS: T 99, pulse ox 88%

PE: Quiet, retrax present, no wheezing?

Labs: None, CXR?

Triage, treat and/or transfer? PEARL: SAY YOUR ABC’s?

W61.92 Struck by other birdsZ63.1 Problems in relationship with in-lawsW45.8XXA Other foreign body or object entering though

skin, initial encounterV52.2XXA Person on outside of pick-up truck or van

injured in collision with two or three-wheeledmotor vehicle in nontraffic accident

V00.32 Snow-ski accidentX92.0 Assault by drowning and submersion while in

bathtubW00.1 Fall from stairs and steps due to ice and snowV97.33XD Sucked into jet engine, subsequent encounter

ICD-10 FOLLIES

David Pittman, Med Page Today

Case #4: Foreign body

18 mo swallowed a nickel, no vomiting, no cough

VS: T 98.7

PE: waddling around exam room, NAD

Labs/image: CXR/KUB

Triage, treat and/or transfer? PEARL: NICKELS ARE GOOD, BATTERIES AND MAGNETS ARE BAD

Case #5: Crush injury

2 yo smashed finger in car door

VS: T 99

PE: crying in room, apprehensive, finger tip and nail partially avulsed, not actively bleeding

Labs/image: Xray

Triage, treat and/or transfer?PEARL: PLASTIC SURGEON IS YOUR BEST FRIEND

Case #6: Nodes 5yo with recurrent fever to 102,

swollen glands, recent dx of mono after 5 days of fever

VS: T 101.8, P 100

PE: pale, diffuse cervical LAD, guarding RUQ, bruising

Labs/image: WBC 52K, H/H wnl, plts 30,000

Triage, treat and/or transfer?PEARL: BEWARE OF NODES

Don’t forget the patient comes first!

Thank you TAPAand

safe travels!