INDEX OF SUSPICION
Elliott M. Friedman MD1
Teri Turner MD2
Danuta Deeb MD3
1 The Jamaica Hospital, Jamaica, NY
2 Baylor College of Medicine, Houston, TX
3 Orlando, FL
This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.
We invite readers to contribute case presentations and discussions.
Case 1 Presentation
A 6-week-old boy who has had no prenatal or newborn problems and has been well previously is brought to the emergency department because he suddenly has developed respiratory distress. On examination, the baby is lethargic, obviously cyanotic, and breathing at 36 breaths/min with intercostal retractions, nasal flaring, and grunting. His temperature is 94°F (34.4°C), heart rate is 140 beats/min, and blood pressure is 78/48 mmHg. Other positive signs include cool extremities and a capillary refill time of 4 sec. He is aerating his lungs well and his breath sounds are clear. No heart murmurs are heard and no hepatosplenomegaly is noted. His femoral and brachial artery pulses are equal but of diminished strength.
An intravenous line is put into an external jugular vein; the state of shock precludes a peripheral cannulation and the external jugular veins are prominent.
