When Intensive Care Is Too Intense: Variations in Standard Practices Across Hospital Acuity Levels.

A 31-day-old infant born at 38 weeks’ gestation presented to the emergency department of a quaternary care children’s hospital in January with 2 days of cough and congestion and 1 day of fever. The baby was eating well and had normal urine and stool output. He did not have vomiting or diarrhea, and several family members had upper respiratory tract infections. The review of systems was otherwise negative. Upon arrival in the emergency department he was febrile to 38.5°C, and initial vital signs were a heart rate of 170 beats per minute, respiratory rate of 40 breaths per minute, blood pressure of 85/50 mmHg, and an oxygen saturation of 98% on room air. Physical examination was significant for moderate respiratory distress, subcostal retractions, and coarse inspiratory crackles throughout the lung fields. The child appeared well hydrated and alert.