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Parent is holding the neonate. Patient has a weak cry.

Vital signs:	T 102.4°F (39.1°C) rectal, HR 215, RR 60, BP 70/35, SpO2 97% on room air.
Weight:	2.7 kg.
Head:	Atraumatic, normocephalic, fontanelle soft.
Eyes:	Pupils 4 mm bilaterally and reactive to light.
Neck:	Supple, full range of motion, no meningismus.
Heart:	Tachycardic, regular, no murmurs/rubs/gallops.
Lungs:	Tachypnea, clear to auscultation bilaterally.
Abdomen:	Moderately distended with high‐pitched bowel sounds; patient screams when abdomen is palpated in all quadrants. No palpable masses. Dark black soft stool in diaper (hemoccult positive, if asked).
Extremities:	No gross deformities; warm extremities with capillary refill two to three seconds.
Skin:	Warm, no rashes, no mottling.
Neurologic:	Moves all extremities spontaneously; weak cry that increases with palpation of the abdomen.

Physical exam findings that are not available on your mannequin may be offered verbally to learners if they ask (e.g., rectal exam and hemoccult testing can be reported if specifically requested by learners).

See flow diagram (Figure 1.5) for further scenario changes described.