Description

Attempt: 3158922

GH is a 26 month old male patient with a past history of Down Syndrome who presents to clinic with mother who reports abdominal pain for the past two days. The mom stated pt fell off bed while at home with her boy friend. She states that the pt has been whining and refusing to eat and has a noticeable bruise to his abdomen. Physical examination revealed hypotension, tachycardia, tachypnea, hypoactive bowel sounds. He also has a faint circumferential macular discoloration at wrists consistent with aging ligature marks. Physical examination also revealed a firm distended abdomen with ecchymoses overlying the epigastrium area. Pertinent negatives include adventitious breath sounds and head trauma.

Attempt: 2776711

GH, a 2 y/o A.A male with a hx of Down Syndrome, ASD, and ASD repair presents with stomach pain x 2 days, crying, withdrawn, bruise on his stomach, one episode of vomiting, rapid breathing, lack of appetite, and decreased urinary output which his urine is a dark-colored with a strong odor and decreased bowel movements. The mother denies head trauma but acknowledged that the child is not acting like himself. PEX reveals poor eye contact, skin is pale, cool, clammy, and mottled; pulse-160; strength: weak, resp. 50, bp: 68/40 bilaterally; hypotensive; circumferential macular discoloration @ wrist with aging ligature marks, ecchymosis 10cm overlying epigastrium- oval shaped, distended abd. with tenderness and rebound to palpation, 2cm umbilical hernia, neg. tympany and shuffling dullness. Has not received the last immunizations for his age.