Case Archive
Pediatric Emergency Medicine
Ref. # 204601

A previously healthy 14-month-old girl was brought to a children's clinic due to vomiting for two days. The exam revealed a low-grade fever but an otherwise alert and well-hydrated child. The next day her mother brought her to the ER for continued vomiting and diarrhea, fever, and decreased urination and activity. Her physical exam was notable for lethargy, pallor, a fever of 102.8, pulse of 202, sunken eyes, lack of tears, and dry mucous membranes. Lab findings included a markedly low serum CO2 of 11 MM/L, an elevated Urea Nitrogen of 24 MG/DL, a greatly increased white blood cell count of 20,200 with a marked bandemia, and evidence of possible urinary tract infection. While in the ER the girl received 100 cc/kg of IV fluids and improved somewhat. She was discharged with treatment with Bactrim for urinary tract infection. The next morning the girl's mother brought her back to the ER in full cardiac arrest. Extensive resuscitative efforts eventually restored cardiac function. The girl was transferred to a major medical center, where she developed multi-organ failure and died four days later. A medQuest pediatric emergency medicine expert opined the ER physician and the nurse practitioner staff under his supervision negligently failed to recognize the severity of the girl's condition during her initial visit. There was clear evidence she was suffering from severe dehydration and sepsis. Although she did improve, pediatric consultation and hospitalization were necessary and indicated. The failure to recognize the girl's condition and hospitalize her for ongoing care caused her cardiopulmonary arrest and resulted in her death.

Pediatric Emergency Medicine
Ref. # 05908

A 2 1/2 year old Pennsylvania boy with sickle cell anemia was brought to the ER with a fever and abdominal pain. Temperature was 105.7, pulse 156, respiratory rate 28. Blood count showed hemoglobin of 6.1 and hematocrit of 17.8. Two hours later the child's temperature remained elevated at 103.9 despite administration of Tylenol and Motrin. After consulting with the child's pediatrician over the phone, the ER physician chose to administer ceftriaxone and discharge the child. At home the child was bathed and put to sleep, then found unconscious and rushed back to the ER. Resuscitation was unsuccessful. An autopsy stated the cause of death was strep pneumonia septicemia. A medQuest pediatric ER specialist opined there was a negligent failure to recognize the well-documented, potential risk of a rapidly progressive infection in a young child with sickle cell anemia. The ER physician and the pediatrician shared potential liability in failing to arrange for hospitalization. With close observation, circulatory support and antimicrobial therapy, the child likely would have survived.

Pediatric Emergency Medicine
Ref. # 82438

A three year old Michigan girl was brought to the ER with a two-inch deep laceration to the lateral aspect of the left ankle. The wound was cleaned and sutured and the child was sent home. She required a left peritoneal tendon repair 26 months later. A medQuest pediatric ER specialist reported the lacerated tendons were negligently missed during the first ER visit as well as the second, when the sutures were checked.

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