A 2-Year-Old Boy Is Brought to the Emergency Department by His

question 251

Multiple Choice

A 2-year-old boy is brought to the emergency department by his grandmother due to abdominal pain and lethargy.  The grandmother reports that he was playing calmly last night when he suddenly began screaming and holding his abdomen.  The pain resolved after several minutes, but the patient has had 5 additional episodes of sudden-onset, severe pain since then.  Today, the grandmother notes that he has no interest in eating or drinking and has been "sleeping all day" but intermittently awakens in pain.  The patient has also had several episodes of nonbloody, nonbilious emesis and "fewer wet diapers than usual."  He has had no fever, diarrhea, or recent infections.  He is an otherwise healthy child with no prior hospitalizations or chronic medical conditions.  The patient takes no medications, and his immunizations are up to date.  Temperature is 37 C (98.6 F) , blood pressure is 90/56 mm Hg, pulse is 160/min, and respirations are 24/min.  During the examination, the boy is sleeping and arouses briefly.  The abdomen has hypoactive bowel sounds and diffuse mild tenderness to palpation.  He is circumcised, with both testes descended and with intact cremasteric reflexes.  Immediately after the examination, the child passes blood in his diaper, as shown in the image below. The appropriate procedure is performed and the intussusception is reduced successfully.  After about an hour of rest, the patient experiences acute onset of severe abdominal pain.  Which of the following is the best next step in immediate management of this patient?

• A)Air enema
• B)CT scan of the abdomen
• C)Intravenous antibiotics
• D)Radiographs of the abdomen
• E)Ultrasound of the abdomen

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Definitions:

Disrupt-then-reframe Technique

A persuasion strategy that involves presenting an unexpected element (disruption) followed by a rational argument (reframe) to persuade someone.

Critical Thinking

The objective analysis and evaluation of an issue in order to form a judgment.

Scarcity Principle

A psychological and economic principle stating that limited supply of a commodity increases its demand and perceived value.

Fast-approaching-deadline Technique

A time management strategy emphasizing the urgency and priority of tasks as deadlines approach, aiming to enhance productivity.