Peds

DC Inst – Peds Fracture

DC, Peds

Male child?????????????????????????

Your son has been evaluated in the Emergency Department today for his ______ pain. His evaluation, including an x-ray of his _____, has revealed a _____ fracture. Your son’s ______ has been splinted in the ER.

Please rest, ice, and elevate your son’s ____ to control pain and inflammation.

Please give your son tylenol/motrin as directed in the attached dosing instructions for discomfort.

Please follow up with a pediatric orthopedic surgeon in about 1 week.

Return to the ER immediately if your son has any worsening or uncontrolled pain, numbness or weakness to his ____, color change to his ____, or for any other concerning symptoms.

Thank you for choosing usfor your child’s care.

Female child??????????????????????????????

Your daughter has been evaluated in the Emergency Department today for her ______ pain. Her evaluation, including an x-ray of her _____, has revealed a _____ fracture. Your daughter’s ______ has been splinted in the ER.

Please rest, ice, and elevate her ____ to control pain and inflammation.

Please give your daughter tylenol/motrin as directed in the attached dosing instructions for discomfort.

Please follow up with a pediatric orthopedic surgeon in about 1 week.

Return to the ER immediately if your daughter has any worsening or uncontrolled pain, numbness or weakness to her ____, color change to her ____, or for any other concerning symptoms.

Thank you for choosing us for your child’s care.

Pediatric Tylenol/Motrin Dosing Chart by Weight

Acetaminophen (Tylenol) Dosing Chart
May give acetaminophen dose every 4 – 6 hours:
Weight Tylenol Milligram Dosage Tylenol Infant drops 80mg/0.8ml Tylenol Children’s liquid160mg/5ml Tylenol Chewables 80mg each Tylenol Junior 160mg each
6 – 8 lbs 40 mg ½ dropper (0.4 ml) N/A N/A N/A
9 – 11 lbs 60 mg ¾ dropper (0.6 ml) N/A N/A N/A
12 – 17 lbs 80 mg 1 dropper (0.8 ml) ½ tsp (2.5 ml) N/A N/A
18 – 23 lbs 120 mg 1 ½ dropper (1.2 ml) 3/4 tsp (3.75 ml) N/A N/A
24 – 35 lbs 160 mg 2 droppers (1.6 ml) 1 tsp (5 ml) 2 tablets 1 tablet
36 – 47 lbs 240 mg 3 droppers (2.4 ml) 1 ½ tsp (7.5 ml) 3 tablets 1 ½ tablet
48 – 59 lbs 320 mg N/A 2 tsp (10 ml) 4 tablets 2 tablets
60 – 71 lbs 400 mg N/A 2 ½ tsp (12.5 ml) 5 tablets 2 ½ tablets
72 – 95 lbs 500 mg N/A 3 tsp (15 ml) 6 tablets 3 tablets
Note: Tylenol suppositories can be used if the child is vomiting or is very resistant to taking medicine by mouth. The suppositories can be cut-up to get the proper dose.

Ibuprofen (Motrin / Advil) Dosing Chart
May give ibuprofen dose every 6 – 8 hours:
Weight Motrin Milligram Dosage Motrin Infant drops 50mg/1.25ml Motrin Children’s liquid100mg/5ml Motrin Chewables 50mg each Motrin Junior100mg each
12 – 17 lbs 50 mg 1 dropper (1.25 ml) ½ tsp (2.5 ml) N/A N/A
18 – 23 lbs 75 mg 1 ½ dropper (1.875 ml) 3/4 tsp (3.75 ml) N/A N/A
24 – 35 lbs 100 mg 2 droppers (2.5 ml) 1 tsp (5 ml) 2 tablets 1 tablet
36 – 47 lbs 150 mg 3 droppers (3.75 ml) 1 ½ tsp (7.5 ml) 3 tablets 1 ½ tablet
48 – 59 lbs 200 mg N/A 2 tsp (10 ml) 4 tablets 2 tablets
60 – 71 lbs 250 mg N/A 2 ½ tsp (12.5 ml) 5 tablets 2 ½ tablets
72 – 95 lbs 300 mg N/A 3 tsp (15 ml) 6 tablets 3 tablets
Note: Motrin should NOT be given to infants less than 6 months old.

DC Inst – Peds Fever

DC, Peds

Male Child ???????????????????????

Your son was evaluated in the Emergency Department today for his fever. His evaluation, including ***, suggests that his symptoms are due to ***.

Please alternate Tylenol and Motrin every 4-6 hours to help control your son’s fever.

Please follow up with your son’s pediatrician within three days.

Return to the Emergency Department immediately if your son experiences severe cough, fevers greater than 100.4°F that cannot be controlled with Tylenol/Motrin, recurrent vomiting, lethargy, seizures, shortness of breath, or any other concerning symptoms.

Thank you for choosing us for your child’s care.

Female child?????????????????????????????????

Your daughter was evaluated in the Emergency Department today for her fever. Her evaluation, including ***, suggests that her symptoms are due to ***.

Please alternate Tylenol and Motrin every 4-6 hours to help control your daughter’s fever.

Please follow up with your daughter’s pediatrician within three days.

Return to the Emergency Department immediately if your daughter experiences severe cough, fevers greater than 100.4°F that cannot be controlled with Tylenol/Motrin, recurrent vomiting, lethargy, seizures, shortness of breath, or any other concerning symptoms.

Thank you for choosing us for your child’s care.

Pediatric Tylenol/Motrin Dosing Chart by Weight

Acetaminophen (Tylenol) Dosing Chart
May give acetaminophen dose every 4 – 6 hours:
Weight Tylenol Milligram Dosage Tylenol Infant drops 80mg/0.8ml Tylenol Children’s liquid160mg/5ml Tylenol Chewables 80mg each Tylenol Junior 160mg each
6 – 8 lbs 40 mg ½ dropper (0.4 ml) N/A N/A N/A
9 – 11 lbs 60 mg ¾ dropper (0.6 ml) N/A N/A N/A
12 – 17 lbs 80 mg 1 dropper (0.8 ml) ½ tsp (2.5 ml) N/A N/A
18 – 23 lbs 120 mg 1 ½ dropper (1.2 ml) 3/4 tsp (3.75 ml) N/A N/A
24 – 35 lbs 160 mg 2 droppers (1.6 ml) 1 tsp (5 ml) 2 tablets 1 tablet
36 – 47 lbs 240 mg 3 droppers (2.4 ml) 1 ½ tsp (7.5 ml) 3 tablets 1 ½ tablet
48 – 59 lbs 320 mg N/A 2 tsp (10 ml) 4 tablets 2 tablets
60 – 71 lbs 400 mg N/A 2 ½ tsp (12.5 ml) 5 tablets 2 ½ tablets
72 – 95 lbs 500 mg N/A 3 tsp (15 ml) 6 tablets 3 tablets
Note: Tylenol suppositories can be used if the child is vomiting or is very resistant to taking medicine by mouth. The suppositories can be cut-up to get the proper dose.

Ibuprofen (Motrin / Advil) Dosing Chart
May give ibuprofen dose every 6 – 8 hours:
Weight Motrin Milligram Dosage Motrin Infant drops 50mg/1.25ml Motrin Children’s liquid100mg/5ml Motrin Chewables 50mg each Motrin Junior100mg each
12 – 17 lbs 50 mg 1 dropper (1.25 ml) ½ tsp (2.5 ml) N/A N/A
18 – 23 lbs 75 mg 1 ½ dropper (1.875 ml) 3/4 tsp (3.75 ml) N/A N/A
24 – 35 lbs 100 mg 2 droppers (2.5 ml) 1 tsp (5 ml) 2 tablets 1 tablet
36 – 47 lbs 150 mg 3 droppers (3.75 ml) 1 ½ tsp (7.5 ml) 3 tablets 1 ½ tablet
48 – 59 lbs 200 mg N/A 2 tsp (10 ml) 4 tablets 2 tablets
60 – 71 lbs 250 mg N/A 2 ½ tsp (12.5 ml) 5 tablets 2 ½ tablets
72 – 95 lbs 300 mg N/A 3 tsp (15 ml) 6 tablets 3 tablets
Note: Motrin should NOT be given to infants less than 6 months old.

DC Inst – Child Cough

DC, Peds

Male child:????????????????????

Your son was evaluated in the Emergency Department today for his cough. His evaluation suggests that his symptoms are likely due to a viral illness.

You can give your son Tylenol or Motrin per the attached dosing instructions as needed for fever.

Please follow up with your son’s pediatrician within three days.

Return to the Emergency Department if your son experiences worsening cough, fever 100.4°F or greater, recurrent vomiting, lethargy, or any other concerning symptoms.

Thank you for choosing us for your care.

Female child: ???????????????????????????????????

Your daughter was evaluated in the Emergency Department today for her cough. Her evaluation suggests that her symptoms are likely due to a viral illness.

You can give your daughter Tylenol or Motrin per the attached dosing instructions as needed for fever.

Please follow up with your daughter’s pediatrician within three days.

Return to the Emergency Department if your daughter experiences worsening cough, fever 100.4°F or greater, recurrent vomiting, lethargy, or any other concerning symptoms.

Thank you for choosing us for your care.

Pediatric Tylenol/Motrin Dosing Chart by Weight

Acetaminophen (Tylenol) Dosing Chart
May give acetaminophen dose every 4 – 6 hours:
Weight Tylenol Milligram Dosage Tylenol Infant drops 80mg/0.8ml Tylenol Children’s liquid160mg/5ml Tylenol Chewables 80mg each Tylenol Junior 160mg each
6 – 8 lbs 40 mg ½ dropper (0.4 ml) N/A N/A N/A
9 – 11 lbs 60 mg ¾ dropper (0.6 ml) N/A N/A N/A
12 – 17 lbs 80 mg 1 dropper (0.8 ml) ½ tsp (2.5 ml) N/A N/A
18 – 23 lbs 120 mg 1 ½ dropper (1.2 ml) 3/4 tsp (3.75 ml) N/A N/A
24 – 35 lbs 160 mg 2 droppers (1.6 ml) 1 tsp (5 ml) 2 tablets 1 tablet
36 – 47 lbs 240 mg 3 droppers (2.4 ml) 1 ½ tsp (7.5 ml) 3 tablets 1 ½ tablet
48 – 59 lbs 320 mg N/A 2 tsp (10 ml) 4 tablets 2 tablets
60 – 71 lbs 400 mg N/A 2 ½ tsp (12.5 ml) 5 tablets 2 ½ tablets
72 – 95 lbs 500 mg N/A 3 tsp (15 ml) 6 tablets 3 tablets
Note: Tylenol suppositories can be used if the child is vomiting or is very resistant to taking medicine by mouth. The suppositories can be cut-up to get the proper dose.

Ibuprofen (Motrin / Advil) Dosing Chart
May give ibuprofen dose every 6 – 8 hours:
Weight Motrin Milligram Dosage Motrin Infant drops 50mg/1.25ml Motrin Children’s liquid100mg/5ml Motrin Chewables 50mg each Motrin Junior100mg each
12 – 17 lbs 50 mg 1 dropper (1.25 ml) ½ tsp (2.5 ml) N/A N/A
18 – 23 lbs 75 mg 1 ½ dropper (1.875 ml) 3/4 tsp (3.75 ml) N/A N/A
24 – 35 lbs 100 mg 2 droppers (2.5 ml) 1 tsp (5 ml) 2 tablets 1 tablet
36 – 47 lbs 150 mg 3 droppers (3.75 ml) 1 ½ tsp (7.5 ml) 3 tablets 1 ½ tablet
48 – 59 lbs 200 mg N/A 2 tsp (10 ml) 4 tablets 2 tablets
60 – 71 lbs 250 mg N/A 2 ½ tsp (12.5 ml) 5 tablets 2 ½ tablets
72 – 95 lbs 300 mg N/A 3 tsp (15 ml) 6 tablets 3 tablets
Note: Motrin should NOT be given to infants less than 6 months old.

DC Inst – Peds CHI

DC, Peds

MALE CHILD:
?????????????????????????????????????????

Your son has been evaluated in the Emergency Department today for his head injury. It is possible that your son has had a minor concussion tonight. Typical symptoms after a concussion include headache, some nausea, and difficulty concentrating. If these symptoms worsen or become severe, bring your son back to the ER.

He should avoid contact contact sports, strenuous exercise, or extended computer use for the next few days, until he is feeling completely well again.

Please follow up with your son’s pediatrician within three days.

Return to the Emergency Department if your son experiences severe headache, vision changes, recurrent vomiting, difficulty with normal activities, lethargy, abnormal behavior, difficulty walking, numbness, weakness, or any other concerning symptoms.

Thank you for choosing us for your son’s care.

FEMALE CHILD:
????????????????????????????????????????????
Your daughter has been evaluated in the Emergency Department today for her head injury. It is possible that your daughter has had a minor concussion tonight. Typical symptoms after a concussion include headache, some nausea, and difficulty concentrating. If these symptoms worsen or become severe, bring your daughter back to the ER.

She should avoid contact contact sports, strenuous exercise, or extended computer use for the next few days, until she is feeling completely well again.

Please follow up with your daughter’s pediatrician within three days.

Return to the Emergency Department if your daughter experiences severe headache, vision changes, recurrent vomiting, difficulty with normal activities, lethargy, abnormal behavior, difficulty walking, numbness, weakness, or any other concerning symptoms.

Thank you for choosing us for your daughter’s care.

PE – Infant Basic

Peds

General Appearance: alert, no apparent distress, appropriately interactive with examiner
Skin: no lesions, no jaundice
Head/Fontanelles: normocephalic, AF_____x_______,  RR normal bilaterally
EENT: conjunctiva clear, nares patent, normal oral mucosa, ears normal placement, TM’s clear bilaterally
Neck: full range of motion
Lungs:  CTA bilaterally, no adventitious breath sounds
CV: normal S1, S2, RRR without murmur normal femoral pulses
Abdomen: soft, no hepatosplenomegaly or masses
Extremities: no deformities
Hips: negative Barlow/Ortolani, > 60° abduction
Genitourinary: Male: testes descended, circ/uncirc    //  Female: normal external genitalia
Neurologic: moves all extremities symmetrically, normal tone, responds to clap, positive moro, grasp/suck/root/toe grasp

RLQ Abdominal Pain

MDM, Peds

This is a *** with RLQ pain, most concerning for ***. Differential diagnoses: appendicitis, ***. Abdominal exam without peritoneal signs. No evidence of acute abdomen at this time. Well appearing. Low suspicion for acute hepatobiliary disease (includng acute cholecystitis), acute infectious processes (pneumonia, hepatitis, pyelonephritis), vascular catastrophe, bowel obstruction or viscus perforation. Presentation not consistent with other acute, emergent causes of abdominal pain at this time.

Plan: labs, UA, CT AP ***, pain control, fluids, serial reassessment

Peds – Appy rule out

Peds

*** is a ***y/o child who presents with abdominal pain, vomiting, anorexia, concerning for appendicitis. Differential includes gastritis or early gastroenteritis, although history suggests appy is at least equally likely. Intussusception, Meckel’s also a possibility but would be atypical given patient age. Similarly volvulus or malrotation unlikely given otherwise well-appearing patient without peritonitic/rigid abdomen. Unlikely to represent UTI given no dysuria, no suprapubic tenderness. Would be an atypical presentation of pneumonia and patient is normoxemic without dyspnea or cough. Low index of suspicion for ***gynececological etiologies such as torsion, TOA, or ectopic given *** OR ***testicular torsion, orchitis/epididymitis given ***.

Plan: ***

Peds – Gastritis – Nontoxic

Peds

*** is a *** y/o otherwise healthy *** with midepigastric pain worsened with eating, most consistent with gastritis. Reassuring that his pain was relieved with OTC antacids. Differential includes GERD, early gastroenteritis, PUD. Low suspicion for referred cardiac etiologies given age and lack of fmhx early heart disease. Denying chest pain. No infectious symptoms (tachypnea, fever/chills, etc) to suggest bacterial infection such as PNA or biliary tree infection. No urinary symptoms to suggest UTI, no RLQ or migratory pain or fever to indicate a concern for appy. No blood/mucus in stool to suggest invasive bacterial species. Otherwise well-appearing child, tolerating adequate PO and not dehydrated.

Plan: discharge to home with return precautions, encourage PO hydration, ***recommend OTC meds such as ranitidine, tums

Peds – Gastro/AGE – Nontoxic

Peds

This is a *** pt presenting with abdominal pain, +fever, +myalgias, +diarrhea, and nausea most consistent with viral gastroenteritis. ***sick contacts with similar symptoms. Differential includes invasive/toxic diarrhea, sepsis, influenza, along with the far less likely surgical etiologies such as volvulus, appendicitis, malro, and SBO. No change in diet or abnormal exposures. No known stagnant water exposure, recent camping/hiking. No dietary history or bloody BM’s suggestive of B. Cereus, S. Aureus, or other invasive bacterial enteric pathogens. Pt with good capillary refill (<2 sec), MMM, and is nonseptic in appearance. Clinically is not dehydrated.  Unlikely to represent unusual manifestation of UTI, GERD, partial or complete anatomical obstruction, or other acute abdomen. Pt tolerating PO rehydration and is very well-appearing.

Plan: Presumed self-limited etiology; plan to DC home with return precautions and oral rehydration education.

Peds Cough – URI

Peds

*** year old *** presenting with cough. Patient is afebrile. Presentation consistent with uncomplicated viral URI given classic history and physical exam, positive sick contacts, and well-appearing child***. No warning signs of systemic infection (fevers, tachypnea) to suggest pneumonia, and lung sounds clear on exam. No photophobia or neck stiffness/pain to suggest meningitis. No rash. No clinical evidence of dehydration and child is taking excellent PO and making multiple wet diapers per day. Patient has attentive parents and good follow up.

Plan: Discharge to home with strict return precautions, encourage PO hydration, return to ***clinic/ER in 48 hours if no improvement