8. Resident-attending conversation in the Emergency Department: Gastroenteritis
Resident: The chief complaint of this patient is vomiting and diarrhea. Linda is an 8 month unvaccinated female who presents to the ED today with fever, vomiting and diarrhea. Not known allergies and no past medical history. She vomits almost after every meal, non-bloody and non-bilious in nature. She was able to take some water this morning, but threw it up immediately after. They have been trying to give her juice to maintain hydration, but have noticed today she has had decreased wet diapers. She has not had any PO intake today, apart from the water in the morning. Her diarrhea alternates from liquid yellow stools to firm yellow ones (all non-bloody). She has around 3-4 stools a day. She has also had an intermittent cough and copious rhinorrhea. Her mom has noticed that she has “felt warm” over the last 2-3 days as well, but has had no temperatures recorded.
Attending: Is anyone in the family also sick? For how long has she been with these symptoms?
Resident: She has 3 sisters at home who have all had “a croupy cough” but no vomiting or diarrhea. She started this morning.
Attending: What about the physical exam?
Resident: She is active and a bit fussy. Her mucous membranes are tacky. In the cardiovascular exam tachycardia is present, but she has strong bilateral pulses and her capillary refill takes less than 3 seconds. Regarding HENT, her oropharynx is clear. Copious clear rhinorrhea is present, and I can see bilateral erythematous tympanic membranes, no pus seen behind either of them. The rest of the physical exam was unremarkable.
Attending: So what is your impression?
Resident: I think she is probably mildly dehydrated, but she is stable, so I would probably try to attempt PO challenge with zofran.
Attending: Ok I agree. Do you think we need any complementary tests?
Resident: Not really. Likely it is a viral gastroenteritis and the onset of her disease was only a few hours ago. I would wait.
Chief complaint: motivo de consulta.
ED (Emergency Department): servicio de urgencias.
Non-bilious: no bilioso.
Decreased wet diapers: moja menos pañales.
PO intake (del latín “per os”, by mouth): tolerancia oral.
Croupy cough: tos perruna.
Mucous membranes are tacky: mucosas pastosas.
Capillary refill: relleno capilar.
HENT (Head, Ears, Nose, Throat): exploración craneal y ORL.
PO challenge with zofran: probar tolerancia oral tras antiemético.