Pediatric Macros & Resources
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Headache/Migraine
Your child was seen today for headaches. They were treated with medications and fluids to help resolve the pain. Your child's evaluation was not concerning for an emergency at this time, however changes in their headache or other symptoms may be concerning and signal a medical emergency for which you need to return for further evaluation. Your child should return to the ER if they experience confusion, worsening headache, weakness or numbness, any changes in vision such as blurring or loss of vision, fevers, pain with neck movement, or other concerning symptoms. . To help their symptoms resolve, be sure to get plenty of sleep and hydrate well. Decrease use of screens including televisions, computers, and phones. Try to rest in dark conditions with minimal stimulation. You should follow up with your child's pediatrican within the next week. Call for an appointment today.
Thank you for choosing the George Washington Emergency Department
Your child was seen today for headaches. They were treated with medications and fluids to help resolve the pain. Your child's evaluation was not concerning for an emergency at this time, however changes in their headache or other symptoms may be concerning and signal a medical emergency for which you need to return for further evaluation. Your child should return to the ER if they experience confusion, worsening headache, weakness or numbness, any changes in vision such as blurring or loss of vision, fevers, pain with neck movement, or other concerning symptoms. . To help their symptoms resolve, be sure to get plenty of sleep and hydrate well. Decrease use of screens including televisions, computers, and phones. Try to rest in dark conditions with minimal stimulation. You should follow up with your child's pediatrican within the next week. Call for an appointment today.
Thank you for choosing the George Washington Emergency Department
Otitis Media, ABX (Wait to give)
Your child was seen today for _ and diagnosed with an ear infection. Most ear infections are viral in nature, however a prolonged ear infection may be due to a bacterial infection. You were given a prescription for an antibiotic, which should be filled only if your child fails to improve with supportive care as discussed. Your child should return to the ER if they experience worsening fevers, worsening ear pain or ear discharge, nausea or vomiting, inability to tolerate oral fluids, or any other concerning symptoms. You should follow up with your pediatrician for re-evaluation in 2-4 days..
Thank you for choosing the George Washington University Emergency Department
Your child was seen today for _ and diagnosed with an ear infection. Most ear infections are viral in nature, however a prolonged ear infection may be due to a bacterial infection. You were given a prescription for an antibiotic, which should be filled only if your child fails to improve with supportive care as discussed. Your child should return to the ER if they experience worsening fevers, worsening ear pain or ear discharge, nausea or vomiting, inability to tolerate oral fluids, or any other concerning symptoms. You should follow up with your pediatrician for re-evaluation in 2-4 days..
Thank you for choosing the George Washington University Emergency Department
Viral Exanthem
Your child was seen today for a rash. Your child’s evaluation _. Most rashes due to a viral infection is self resolving, and will not leave any permanent lesions. Your child should return to the ER if they experience fever greater than 102 degrees, pain associated with their rash, spreading redness or swelling from the rash, headaches or vomiting, increased irritability, inability to tolerate oral fluids, diarrhea, or any other concerning symptoms. You should follow up with your pediatrician _.
Thank you for choosing the George Washington University Emergency Department
Your child was seen today for a rash. Your child’s evaluation _. Most rashes due to a viral infection is self resolving, and will not leave any permanent lesions. Your child should return to the ER if they experience fever greater than 102 degrees, pain associated with their rash, spreading redness or swelling from the rash, headaches or vomiting, increased irritability, inability to tolerate oral fluids, diarrhea, or any other concerning symptoms. You should follow up with your pediatrician _.
Thank you for choosing the George Washington University Emergency Department
Abdominal Pain, fill-in
Your child was seen today for abdominal pain. Your child’s evaluation _. Your child should return to the ER if they experience fever greater than 102 degrees, worsening abdominal pain, blood in stools, worsening nausea or vomiting, inability to tolerate oral fluids, or any other concerning symptoms. You should follow up with your pediatrician _.
Thank you for choosing the George Washington University Emergency Department
Your child was seen today for abdominal pain. Your child’s evaluation _. Your child should return to the ER if they experience fever greater than 102 degrees, worsening abdominal pain, blood in stools, worsening nausea or vomiting, inability to tolerate oral fluids, or any other concerning symptoms. You should follow up with your pediatrician _.
Thank you for choosing the George Washington University Emergency Department
Abdominal Pain, Unknown Cause
Today, your child was seen in the ER for abdominal pain. Although your child’s evaluation did not show a specific cause for their pain, it not seem to be due to a serious cause at this time. However, things can change,you’re your child should see their pediatrician or return to the ER if they have vomiting that prevents them from tolerating oral fluids, worsening of pain, fever of 100.5 or higher, any other new or concerning symptoms. Otherwise, please see their pediatrician in 2 days for re-evaluation.
Thank you for choosing the George Washington Emergency Department.
Today, your child was seen in the ER for abdominal pain. Although your child’s evaluation did not show a specific cause for their pain, it not seem to be due to a serious cause at this time. However, things can change,you’re your child should see their pediatrician or return to the ER if they have vomiting that prevents them from tolerating oral fluids, worsening of pain, fever of 100.5 or higher, any other new or concerning symptoms. Otherwise, please see their pediatrician in 2 days for re-evaluation.
Thank you for choosing the George Washington Emergency Department.
Cold/Viral Illness
Your child was seen today for _. Their symptoms appear to be due to a viral illness, and their evaluation was reassuring. Viral illnesses are treated with supportive care, including increasing fluid intake, over the counter fever and pain reducers, and rest. To limit the spread of your child’s symptoms to others you should wash your hands and your child’s hands frequently and keep surfaces in your home clean. Their condition should improve over the next 5 days with the care discussed. If you experience worsening or prolonged symptoms, this may be due to an additional illness or worsening illness, and your child should return to the ER. You should return if your child experiences increased fevers, increased or change in color of sputum, changes in vision such as blurry vision, neck stiffness, confusion, inability to tolerate oral fluids, or other concerns. You should follow up with your pediatrician in 2-3 days for further evaluation.
Thank you for choosing the George Washington Emergency Department
Your child was seen today for _. Their symptoms appear to be due to a viral illness, and their evaluation was reassuring. Viral illnesses are treated with supportive care, including increasing fluid intake, over the counter fever and pain reducers, and rest. To limit the spread of your child’s symptoms to others you should wash your hands and your child’s hands frequently and keep surfaces in your home clean. Their condition should improve over the next 5 days with the care discussed. If you experience worsening or prolonged symptoms, this may be due to an additional illness or worsening illness, and your child should return to the ER. You should return if your child experiences increased fevers, increased or change in color of sputum, changes in vision such as blurry vision, neck stiffness, confusion, inability to tolerate oral fluids, or other concerns. You should follow up with your pediatrician in 2-3 days for further evaluation.
Thank you for choosing the George Washington Emergency Department
Throat Pain -- Viral
Your child was seen today for throat pain and _. Their symptoms appear to be due to a viral illness, and their evaluation was reassuring. Viral illnesses are treated with supportive care, including increasing fluid intake, over the counter fever and pain reducers, and rest. To limit the spread of your child’s symptoms to others you should wash your hands and your child’s hands frequently and keep surfaces in your home clean. Their condition should improve over the next 5 days with the care discussed. If you experience worsening or prolonged symptoms, this may be due to an additional illness or worsening illness, and your child should return to the ER. You should return if your child experiences increased fevers, increased or change in color of sputum, changes in vision such as blurry vision, neck stiffness, confusion, inability to tolerate oral fluids, or other concerns. You should follow up with your pediatrician in 2-3 days for further evaluation.
Thank you for choosing the George Washington Emergency Department
Your child was seen today for throat pain and _. Their symptoms appear to be due to a viral illness, and their evaluation was reassuring. Viral illnesses are treated with supportive care, including increasing fluid intake, over the counter fever and pain reducers, and rest. To limit the spread of your child’s symptoms to others you should wash your hands and your child’s hands frequently and keep surfaces in your home clean. Their condition should improve over the next 5 days with the care discussed. If you experience worsening or prolonged symptoms, this may be due to an additional illness or worsening illness, and your child should return to the ER. You should return if your child experiences increased fevers, increased or change in color of sputum, changes in vision such as blurry vision, neck stiffness, confusion, inability to tolerate oral fluids, or other concerns. You should follow up with your pediatrician in 2-3 days for further evaluation.
Thank you for choosing the George Washington Emergency Department
Throat Pain -- Strep Throat
Your child was seen today for throat pain and _. Their symptoms appear to be due to strep throat, a bacterial infection. They were treated with antibiotics. If you were given a prescription, you should continue the antibiotics until completed.. To limit the spread of your child’s symptoms to others you should wash your hands and your child’s hands frequently and keep surfaces in your home clean. Their condition should improve over the next 5 days with the care discussed. If you experience worsening or prolonged symptoms, this may be due to an additional illness or worsening illness, and your child should return to the ER. You should return if your child experiences increased fevers, increased or change in color of sputum, changes in vision such as blurry vision, neck stiffness, confusion, inability to tolerate oral fluids, or other concerns. You should follow up with your pediatrician in 2-3 days for further evaluation.
Thank you for choosing the George Washington Emergency Department
Your child was seen today for throat pain and _. Their symptoms appear to be due to strep throat, a bacterial infection. They were treated with antibiotics. If you were given a prescription, you should continue the antibiotics until completed.. To limit the spread of your child’s symptoms to others you should wash your hands and your child’s hands frequently and keep surfaces in your home clean. Their condition should improve over the next 5 days with the care discussed. If you experience worsening or prolonged symptoms, this may be due to an additional illness or worsening illness, and your child should return to the ER. You should return if your child experiences increased fevers, increased or change in color of sputum, changes in vision such as blurry vision, neck stiffness, confusion, inability to tolerate oral fluids, or other concerns. You should follow up with your pediatrician in 2-3 days for further evaluation.
Thank you for choosing the George Washington Emergency Department
Chest Pain -- Unknown Cause
Today, you were seen in the ER for your chest pain. Your EKG, chest x-ray, and bloodwork didn't show any explanation for your symptoms. The exact cause for your pain is unclear. Today, your evaluation was reassuring, and your chest pain does not appear to be an emergency at this time. However, things can change, and you should see your doctor or return to the ER if you have worsening of your chest pain, difficulty breathing, fainting, unusual sweating with your pain, any other new or concerning symptoms. Please follow-up with your primary doctor within 1-2 days for a recheck.
Thank you for choosing the George Washington Emergency Department.
Today, you were seen in the ER for your chest pain. Your EKG, chest x-ray, and bloodwork didn't show any explanation for your symptoms. The exact cause for your pain is unclear. Today, your evaluation was reassuring, and your chest pain does not appear to be an emergency at this time. However, things can change, and you should see your doctor or return to the ER if you have worsening of your chest pain, difficulty breathing, fainting, unusual sweating with your pain, any other new or concerning symptoms. Please follow-up with your primary doctor within 1-2 days for a recheck.
Thank you for choosing the George Washington Emergency Department.
Palpitations
Today, your child was seen in the ER for palpitations or a rapid heart rate. Their EKG and evaluation was reassuring, but did not find a specific cause for their symptoms. A change in their symptoms may indicate an emergency; you should return to the ER if they experience chest pain, shortness of breath, worsening or continuation of their palpitations, or any other concerns. Please follow up with your pediatrician in the next 2-4 days for re-evaluation. If They continue to have frequent palpitations, talk to your pediatrician about using a cardiac monitor or other devices to help monitor their heart rate and rhythm.
Thank you for choosing the George Washington Emergency Department.
Today, your child was seen in the ER for palpitations or a rapid heart rate. Their EKG and evaluation was reassuring, but did not find a specific cause for their symptoms. A change in their symptoms may indicate an emergency; you should return to the ER if they experience chest pain, shortness of breath, worsening or continuation of their palpitations, or any other concerns. Please follow up with your pediatrician in the next 2-4 days for re-evaluation. If They continue to have frequent palpitations, talk to your pediatrician about using a cardiac monitor or other devices to help monitor their heart rate and rhythm.
Thank you for choosing the George Washington Emergency Department.
Asthma Exacerbation
Your child was seen today for an asthma exacerbation. After treatment with oxygen and medications, their breathing improved. You should continue to use the albuterol inhaler as instructed, and prescribed medications as directed. It is important to use the Albuterol inhaler appropriately. If your child experiences a worsening of their breathing, shortness of breath, swelling of their throat, trouble breathing, chest pain, or other concerning symptoms, you should return to the ER. During Heat Advisories or when air quality is poor, it is important to be more aware of asthma symptoms and use your child’s asthma medications as needed. You should also keep track of possible triggers for your asthma to help prevent future attacks. Please follow up with their pediatrician in the next 3-5 days to evaluate your child’s current asthma medications and any need for changes.
Thank you for choosing the George Washington Emergency Department.
Your child was seen today for an asthma exacerbation. After treatment with oxygen and medications, their breathing improved. You should continue to use the albuterol inhaler as instructed, and prescribed medications as directed. It is important to use the Albuterol inhaler appropriately. If your child experiences a worsening of their breathing, shortness of breath, swelling of their throat, trouble breathing, chest pain, or other concerning symptoms, you should return to the ER. During Heat Advisories or when air quality is poor, it is important to be more aware of asthma symptoms and use your child’s asthma medications as needed. You should also keep track of possible triggers for your asthma to help prevent future attacks. Please follow up with their pediatrician in the next 3-5 days to evaluate your child’s current asthma medications and any need for changes.
Thank you for choosing the George Washington Emergency Department.
Hyperglycemia (Diabetic)
Your child was seen today and found to have elevated blood sugar. They were treated with medication to lower their blood sugar to a safe level. It is important to keep your child’s glucose in a safe level to prevent future damage to their body. You should check your child’s blood sugar as discussed, and follow up with your pediatrician or endocrinology clinic for further management. Your child should return to the ER if they have fevers, chills, altered mental status or confusion, abdominal pain, vomiting, or increased urinary frequency or ketones in their urine.
Thank you for choosing the George Washington Emergency Department
Your child was seen today and found to have elevated blood sugar. They were treated with medication to lower their blood sugar to a safe level. It is important to keep your child’s glucose in a safe level to prevent future damage to their body. You should check your child’s blood sugar as discussed, and follow up with your pediatrician or endocrinology clinic for further management. Your child should return to the ER if they have fevers, chills, altered mental status or confusion, abdominal pain, vomiting, or increased urinary frequency or ketones in their urine.
Thank you for choosing the George Washington Emergency Department
Sickle Cell Pain
Today, your child was seen for a sickle cell pain crisis. They were treated with pain medications and fluids, and their labs were reassuring. Their evaluation was reassuring and did not show signs of emergent effects from their sickle cell disease. Please follow-up with your child’s primary doctor or hematologist within the next 2-3 days for a recheck and further recommendations on management of your sickle cell disease. In the meantime, you may use the prescribed pain medication. Please be cautious with the use of these medications, as they may result in drowsiness; please don't use these medications before driving, swimming, or any other potentially dangerous activities. Changes in their symptoms may indicate a need to return.
Please return to the ER if your child has:
-pain that is not controlled with medications
-weakness of any part of their body
-fever of 100.4 or higher
-difficulty breathing or chest pain
-any other new or concerning symptoms
Thank you for choosing the George Washington Emergency Department
Today, your child was seen for a sickle cell pain crisis. They were treated with pain medications and fluids, and their labs were reassuring. Their evaluation was reassuring and did not show signs of emergent effects from their sickle cell disease. Please follow-up with your child’s primary doctor or hematologist within the next 2-3 days for a recheck and further recommendations on management of your sickle cell disease. In the meantime, you may use the prescribed pain medication. Please be cautious with the use of these medications, as they may result in drowsiness; please don't use these medications before driving, swimming, or any other potentially dangerous activities. Changes in their symptoms may indicate a need to return.
Please return to the ER if your child has:
-pain that is not controlled with medications
-weakness of any part of their body
-fever of 100.4 or higher
-difficulty breathing or chest pain
-any other new or concerning symptoms
Thank you for choosing the George Washington Emergency Department
Seizure (known disorder)
Your child was seen today after a seizure. Their labs, imaging, and evaluation was reassuring. If your child is currently on an anti-epileptic medication, it is important to continue taking them. You should follow up with your child's neurologist within 3 days for re-evaluation and to discuss any changes or additions to your current medications. You should return to an Emergency Room or call 911 if your child has additional seizures, trouble walking, speaking, numbness, weakness, fevers,chills, or any other concerns.
Thank you for choosing the George Washington Emergency Department
Your child was seen today after a seizure. Their labs, imaging, and evaluation was reassuring. If your child is currently on an anti-epileptic medication, it is important to continue taking them. You should follow up with your child's neurologist within 3 days for re-evaluation and to discuss any changes or additions to your current medications. You should return to an Emergency Room or call 911 if your child has additional seizures, trouble walking, speaking, numbness, weakness, fevers,chills, or any other concerns.
Thank you for choosing the George Washington Emergency Department
Concussion
Your child was seen today for _. Their symptoms may be due to a mild concussion, or closed head injury. Their symptoms were not concerning for a more serious cause, however a change in their symptoms may indicate a need for re-evaluation and potentially further evaluation such as imaging. You should return if your child has continued or worsening headaches, nausea or vomiting, confusion or trouble speaking or walking, or other concerns. Your child should not participate in any activities that increase the chance for a repeat concussion. To help your child return to school and play, and decrease their post-concussive symptoms, follow these instructions; Be sure to get plenty of sleep. Take daytime rests or naps when fatigued. Your child may need more frequent breaks from school and other activities. Your child may experience symptoms such as headaches, dizziness, and delayed thought processes. These symptoms will be made worse with increasing exertion. Decrease use of screens including televisions, computers, and phones. Try to rest in dark conditions with minimal stimulation. You should follow up with your pediatrician within the next 3-4 days. Call for an appointment today.
For more information regarding concussions and returning to daily activities; http://www.cdc.gov/headsup/
Thank you for choosing the George Washington Emergency Department
Your child was seen today for _. Their symptoms may be due to a mild concussion, or closed head injury. Their symptoms were not concerning for a more serious cause, however a change in their symptoms may indicate a need for re-evaluation and potentially further evaluation such as imaging. You should return if your child has continued or worsening headaches, nausea or vomiting, confusion or trouble speaking or walking, or other concerns. Your child should not participate in any activities that increase the chance for a repeat concussion. To help your child return to school and play, and decrease their post-concussive symptoms, follow these instructions; Be sure to get plenty of sleep. Take daytime rests or naps when fatigued. Your child may need more frequent breaks from school and other activities. Your child may experience symptoms such as headaches, dizziness, and delayed thought processes. These symptoms will be made worse with increasing exertion. Decrease use of screens including televisions, computers, and phones. Try to rest in dark conditions with minimal stimulation. You should follow up with your pediatrician within the next 3-4 days. Call for an appointment today.
For more information regarding concussions and returning to daily activities; http://www.cdc.gov/headsup/
Thank you for choosing the George Washington Emergency Department
Back Pain
Your child was seen in the ER for back pain. Their physical exam and evaluation was reassuring, and although an exact cause of your back pain was not found today, it does not appear to be an emergency. Please follow up with your pediatrician in the next 2-4 days. Please return to ER if your child has worsening pain in the back, numbness, weakness or pain in their legs, loss of bladder or bowel function, or other concerns.
Thank you for choosing the George Washington Emergency Department
Your child was seen in the ER for back pain. Their physical exam and evaluation was reassuring, and although an exact cause of your back pain was not found today, it does not appear to be an emergency. Please follow up with your pediatrician in the next 2-4 days. Please return to ER if your child has worsening pain in the back, numbness, weakness or pain in their legs, loss of bladder or bowel function, or other concerns.
Thank you for choosing the George Washington Emergency Department
PECARN <2 years old
Patient here after sustaining a minor head injury. Discussed with the parent the possibility of a traumatic brain injury, warning signs to identify for return, and further treatment plan including resting in a dark room, decreased use of screens, decreased work load, and step-wise progression back to normal activities. The patient has _ major criteria for imaging, and _ minor criteria for observation.
Major: The patient was _ GCS <15, _ AMS, _ palpable skull fracture
Minor: The patient has _ non-frontal scalp hematoma, _ LOC >5 seconds, _ severe mechanism, _ ped struck, _ bicyclist without helmet, _ fall >1 meter, _ head struck by high-impact object, _ abnormal activity per parents.
One major criteria = 4.3% risk of cTBI
One minor criteria = 0.9% risk of cTBI
Patient here after sustaining a minor head injury. Discussed with the parent the possibility of a traumatic brain injury, warning signs to identify for return, and further treatment plan including resting in a dark room, decreased use of screens, decreased work load, and step-wise progression back to normal activities. The patient has _ major criteria for imaging, and _ minor criteria for observation.
Major: The patient was _ GCS <15, _ AMS, _ palpable skull fracture
Minor: The patient has _ non-frontal scalp hematoma, _ LOC >5 seconds, _ severe mechanism, _ ped struck, _ bicyclist without helmet, _ fall >1 meter, _ head struck by high-impact object, _ abnormal activity per parents.
One major criteria = 4.3% risk of cTBI
One minor criteria = 0.9% risk of cTBI
PECARN > 2 years old
Patient here after sustaining a minor head injury. Discussed with the parent the possibility of a traumatic brain injury, warning signs to identify for return, and further treatment plan including resting in a dark room, decreased use of screens, decreased work load, and step-wise progression back to normal activities. The patient has _ major criteria for imaging, and _ minor criteria for observation.
Major: The patient was _ GCS <15, _ AMS, _ signs of basilar skull fracture
Minor: The patient has _ vomiting, _ LOC, _ severe mechanism, _ ped struck, _ bicyclist without helmet, _ fall >2 meter, _ head struck by high-impact object, _ severe headache
One major criteria = 4.3% risk of cTBI
One minor criteria = 0.9% risk of cTBI
Patient here after sustaining a minor head injury. Discussed with the parent the possibility of a traumatic brain injury, warning signs to identify for return, and further treatment plan including resting in a dark room, decreased use of screens, decreased work load, and step-wise progression back to normal activities. The patient has _ major criteria for imaging, and _ minor criteria for observation.
Major: The patient was _ GCS <15, _ AMS, _ signs of basilar skull fracture
Minor: The patient has _ vomiting, _ LOC, _ severe mechanism, _ ped struck, _ bicyclist without helmet, _ fall >2 meter, _ head struck by high-impact object, _ severe headache
One major criteria = 4.3% risk of cTBI
One minor criteria = 0.9% risk of cTBI
Sinusitis
Patient here with acute sinusitis. Patient’s symptoms have lasted _ days, is _ currently on immunosuppressive medications, and symptoms are _ severe or worsening. Given that 98% of sinusitis is viral and resolve within 10-14 days, the risk of antibiotic therapy at this time would outweigh any benefit to the patient, and could contribute to antibiotic-resistant infections. Per the ACEP Choosing Wisely recommendations, I will treat symptomatically and instruct the patient to return if symptoms do worsen or are prolonged.
Patient here with acute sinusitis. Patient’s symptoms have lasted _ days, is _ currently on immunosuppressive medications, and symptoms are _ severe or worsening. Given that 98% of sinusitis is viral and resolve within 10-14 days, the risk of antibiotic therapy at this time would outweigh any benefit to the patient, and could contribute to antibiotic-resistant infections. Per the ACEP Choosing Wisely recommendations, I will treat symptomatically and instruct the patient to return if symptoms do worsen or are prolonged.