Phone Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2025-05-27 Encounter: Spruce text message with photo review (photo of rash sent by parent) CC: 14-month-old with fever, irritability, and possible heat exhaustion after prolonged heat exposure in Florida, with subsequent rash, diarrhea, and abdominal distension. HPI: Griffin, approximately 14 months old (turned 1 in March 2025), developed fever of 101.6°F, irritability, and disrupted sleep after a long bike ride in hot, muggy Florida weather where he sat in a Burley trailer described as a 'little hot box.' Over the following days the fever persisted at 100°F after returning to Minnesota, treated with Genexa Tylenol 5 mL with partial relief; he also experienced chills/shivering but maintained appetite and hydration. By day 4 the fever broke but he developed diarrhea, runny nose, and small red bumps on his face. By day 6 the rash was fading but he had intermittent back-arching, crying episodes suggestive of abdominal discomfort, reduced stool frequency, and a visibly distended abdomen. Assessment: Dr. Hobbs assessed the initial presentation as difficult to differentiate between heat exhaustion and viral illness at this age. The subsequent rash was attributed to the causative virus. Abdominal distension and intermittent discomfort were attributed to post-illness constipation and the overall illness working through his system. Plan: Keep child inside and cool, push fluids. Monitor for fever >104°F, fever lasting >4 days, poor fluid intake/urine output, respiratory concerns, or extreme irritability/lethargy. Rash expected to resolve in a few days. Parent advised to trust instincts and expect continued improvement. Follow-up in-person well-child visit scheduled for June 5, 2025. Medications: - Acetaminophen (Genexa Tylenol) 5 mL (ongoing (parent-initiated, already in use)) Key clinical quotes: "Symptoms are pretty vague at that age, they can include vomiting and lethargy, but it's often hard to tell the difference between illness and exhaustion" "The rash is almost certainly from whatever virus is causing the fever. It will probably be there for a few days." "I strongly suspect it's all the illness working its way through and I agree, he looks distended and it's very likely because he's not been pooping the same amount." Source: Spruce conversation t_2GPR3H3CA4G00