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Echocardiograms in Typical vs Incomplete Kawasaki’s

On my first shift in the Children’s ED, I saw a child with what appeared to be Kawasaki’s Disease. She was a referral patient who had been seeing her PCP throughout her current illness. The child’s PCP had done appropriate lab work on her, and the results combined with the child’s clinical picture warranted a referral to our ED for further evaluation and management. When she presented to us, her symptoms seemed to be resolving. She had bilateral conjunctivitis that her mom stated was improving, she had a mild rash and swelling of her tongue and she had a dry and peeling rash in her genital region. Her mother stated that her limbs had been swollen but were now returning to normal size and that her fever had been high and unrelenting for several days, but was normal (36.7 and 37.0) in our ED. To me, this child was healing and did not require treatment at this time. But the question was whether or not an echocardiogram was indicated for this patient. [...]