When To Refer 10 year old with chest pain. History Auscultation Diagnosis Refer? Patient History 10 year old boy experiencing periodic non-exertional chest pain. Discomfort is sometimes associated with inspiration. Experiencing periodic palpitations. Auscultation Findings FeatureFindings murmurNo location--- pansystolic--- harsh--- loud--- clickYes splitNo Refer? Should you refer the patient? YesNo Table of Contents 14 month old girl. Failure to thrive. 26 month old boy 34 year old with fainting episode 410 year old with chest pain. 56 month old with poor appetite 612 year old with respiratory infections 7Twelve year old girl with periodic dizziness 8Eleven year old girl seen after bicycle accident 9Eight year old girl with elevated temperature 10Eight year old boy with generalized malaise 11Fifteen year old boy complains of dizziness