Case Scenario 1: EMERGENCY MEDICINE
A 4 1/2 month old boy was brought to the emergency room by his mother. His mother reported that he had a fever and poor appetite. She denied that he had vomiting or diarrhea.
The child was awake and quiet while nursing triage was performed. Triage vital signs were: 100.7 axillary temperature, 102.5 rectal temperature, 172 pulse, 60 respiration. Physical examination revealed an inguinal hernia. A two-minute attempt to reduce the hernia, made by the ER attending physician, was unsuccessful. A surgical consultation was requested. A flat plate of the abdomen was ordered.
A surgical resident examined the patient and also attempted to reduce the hernia. The shift ended. The surgical resident saw the infant once more. The infant was discharged by the original ER resident, on the instruction of the original ER attending physician. The abdominal flat plate was not accomplished prior to discharge.