Hot Seat #257: Close Call
Posted on: April 27, 2026, by : Brittany Fitzpatrick
Case by Fatima Sallman, CNH PEM Fellow
As the sole ED provider overnight in a community peds ED, you are seeing a 12-year-old female with hx of depression and anxiety who was brought in by her parents after she disclosed to them that she took seven 200 mg ibuprofen tablets approximately 2 hours ago. She denies abdominal pain, nausea, or vomiting. No recent intercurrent illness.
On private interview she states that she took the pills because she “wanted to feel something different.” She had been sleeping more than usual, increasingly withdrawn over the past month after a falling out with her friends at school, and her grades have started to drop. She follows with a psychiatrist outpatient and has never been hospitalized for inpatient mental health treatment. No other reported prior suicidal attempts. She does not take any regular medications. Denies sexual activity or substance use.
Vital Signs: Weight: 40 kg. Temp 37.1 C, HR 88 bpm, BP 106/64 mmHg, RR 16 breaths/min, 100% sats on RA
| General | Tearful, calm, and cooperative. Appears stated age. No acute distress. |
| HEENT | Normocephalic, atraumatic. Pupils equal, round, reactive to light. Oropharynx clear. |
| Cardiovascular | Regular rate and rhythm, no murmurs. |
| Respiratory | Clear to auscultation bilaterally, no increased work of breathing. |
| Abdomen | Soft, mild epigastric tenderness to deep palpation, non-distended, no guarding or rigidity. |
| Skin | No lacerations, bruising, or signs of other self-harm. No rashes. |
| Neurologic | Alert and oriented x4, normal gait, no focal deficits. |
| Psychiatric | Tearful but engaged. Denies current suicidal ideation. Expresses remorse. Linear thought process. No evidence of psychosis or disorganized thought. |
It’s 2 am and there is no social work coverage until the morning. As you update the family on the patient’s lab work, the patient says “I wasn’t really trying to hurt myself. I just wanted my parents to pay attention to me. Can I please just go home?”
The family has an outpatient psychiatrist and says she already has an appointment again with them in 2 weeks. They are requesting discharge.
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