It’s a Sunday evening in a local South Texas emergency room with the expected ER traffic for a weekend evening. Lots of simple traumas: ankle sprains, abrasions, lacerations, falls, common URI symptoms, and fevers.
The EMS radios in with a call of a five-year-old male who has altered mental status. The patient is brought in around five minutes later and placed in an open emergency room. The patient is accompanied by an adult monitor and is triaged — vitals are taken and he is placed in a hospital gown. He has normal vitals and is deemed to be a Level 3 triage secondary to his chief complaint. He was subsequently seen within 10 to 15 minutes upon arrival to the ER via EMS.
Upon entering the room, I see a small, thin child lying anxiously on the bed. I begin to ask the adult monitor a series of questions trying to obtain a history of the patients presenting complaints. He advised me that the child has not been acting appropriately over the last three to four hours. He has recently been placed in this detention center secondary to being removed from his father, as both he and his father were caught entering the country illegally. The patient has refused any oral intake including water or food and has not been able to communicate with any of the caregivers at the detention facility. The monitor tells me that he is unable to tell me if he has no previous history of any significant past medical illnesses, surgeries or if the child takes any daily medications.
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