Medical Case Study: Patient Demographics

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Patient Demographics

Twelve-year-old Hispanic male D.C. presented to Advocate Illinois Masonic Medical Center Emergency Department the morning of May 14, 2015, accompanied by his mother, for complaints of abdominal pain and vomiting that began that morning at 0100. While in the ED, D.C. complained of abdominal pain which he rated ten out of ten, so he was given a GI cocktail with Pepto-Bismol, as well as morphine for pain and Zofran for nausea, and his pain decreased to seven out of ten. Due to D.C.’s complaints of abdominal pain, which included his right lower quadrant, the ED physician caring for him ordered an ultrasound of his appendix. This ultrasound was non-diagnostic, as D.C.’s appendix was not visualized. Because he had a clinical …show more content…

likely had gastroenteritis, but the Pediatric Hospitalist ordered a surgical consult to investigate the possibility of appendicitis further. At that time, the surgeon felt the suspicion for appendicitis was low, because although D.C.’s white blood cell (WBC) count was 20.9 thousand/mcL, his C-reactive protein (CRP) was 0.7 mg/dL and he did not have rebound right lower quadrant tenderness. CRP has high predictive value on admission in a patient for whom appendicitis is being investigated. Children who have a CRP greater than 3 mg/dL have a greater risk of complications, and therefore are more likely to need early interventions and close monitoring (Gavela, Cabeza, Serrano, & Casado-Flores, 2012, p. 416). The plan for D.C. was to observe him, do serial abdominal examinations, and obtain a repeat CBC in the morning to evaluate his clinical …show more content…

I remembered discussing with a pediatric surgeon in the past the fact that CRP is a more crucial piece of the diagnostic puzzle than WBC count for children for whom appendicitis is being ruled out, and although I had mentioned this in morning rounds, the Pediatric Hospitalist physician said that she did not feel another CRP was necessary. The labs drawn on D.C. the morning of May 15 had shown a WBC count of 19.3, a slight normalization from the prior day. After I verbalized again that I thought another CRP should be obtained since I noted that D.C.’s pain level was not improving, the Pediatric Hospitalist agreed to order a repeat CBC and CRP for the afternoon. The results showed a WBC of 24.7 and a CRP of 22. Due to an increased WBC count and significantly elevated CRP, Pediatric Surgery was notified and a stat computed tomography (CT) scan of the abdomen and pelvis with contrast was ordered. The CT scan showed perforated appendicitis and a fatty liver, so blood cultures were drawn and D.C. was started on ceftriaxone and metronidazole intravenously. He continued to receive these antibiotics IV, as well as medication for pain control, until his discharge home on May 21 with a prescription for Augmentin to be taken by mouth three times a day for five days. He had an appointment with his pediatrician for May 22 and one with Pediatric Surgery for May 28. Surgery was planned for approximately six to eight weeks after discharge, once

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