MDM //

with vaccinations up to date_, full term, otherwise healthy boy presenting with fever and constellation of upper respiratory symptoms. Currently well appearing, nontoxic. Given history and exam, low suspicion for serious bacterial infection including meningitis, pneumonia, UTI or bacteremia. Tolerating PO and appearing euvolemic. Mild fever and well appearing after ibuprofen administration. No meningismus, otherwise at baseline activity level with low suspicion for CNS infection. Query likely viral etiology. Discussed low risk but possible UTI and offered catherterized urine sampling, but mutual decision making at this time to defer after discussion with parents_. Discussed alternating tylenol and ibuprofen as directed over the counter for antipyresis. Discussed strict return precautions for worsening of symptoms, increased respiratory effort, signs of CNS infection including but not limited to changes in mental status or vomiting, or fever for more than 5 days. Discussed prompt follow up with primary pediatrician in 24-48 hours for recheck or return to ED sooner if concern or if cannot schedule appointment.



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