Hey folks, I just want to ask a question if I may. This evening in the general ER where I work I saw a 2 year and one day old who was previously healthy, but who developed a cough and fever during the afternoon at daycare. The kid would not eat supper, but did take fluids. Tylenol was given by the parents. Two hours later the child was brought in because the temp at home was 39. At our triage the child was crying. The axillary temp was 37.8, HR 180, RR 24, sat 95. The child was alert, had normal stranger anxiety, and a wet sounding cough. A CXR was done, and even though it was a poor quality due to rotation on the PA, the right side of the heart border had a moth eaten appearance, and the right lung looked whiter than the left. I went back to talk to the family, and the oral temp was now 37.5, and the HR was 195 with the child sitting calmly on the mom's lap.
I called our local Children's hospital to transfer the child, and the PEM attending got quite bent out of shape that I wanted to transfer them a child with only one abnormal vital sign, and told me to watch the child for a few hours to see which way things went. She also said "we send home lots of tachycardic kids."
The long and the short is, in my old age am I getting too cautious in wanting this kid to be at a Peds hospital? Do you folks send home kids with heart rates in the 180 to 200 range when there is the suspicion of pneumonia?
My second related question, is there some ratio one can use to correlate an appropriate HR rise to a temperature?
Thanks in advance
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