TemplateHydroceleTap a choice or type a Repertoire Line to see how the note changes. Defaults are what the template inserts on its own.Try a Repertoire Linehydrocelehydrocele: right, communicatingscrotal fluid: bilateral, persistenthydrocele: hernia concernscrotal swelling: testis not felt, recheck hydrocelehydrocele: tenderhydrocele: irreducible, send to edPractice wording only: leave out patient details. Nothing typed here is saved or sent. Practice a case insteadDiagnosisChoose oneTitleInguinal herniaLateralityChoose oneFirst lineRightLeftBilateralAssessmentChoose onePainless scrotal swelling that transilluminates with a normal testis, consistent with a hydroceleDefaultSwelling that changes size during the day, consistent with a communicating hydroceleGroin bulge that reduces, concerning for an inguinal herniaTestis not clearly felt through the fluidPainful scrotal swellingFirm groin bulge that does not reduce, concerning for an incarcerated herniaWarning findings presentChoose anypaintendernessan irreducible groin bulgeWarning findings absentChoose anypainDefaulttendernessDefaultirreducible groin bulgeDefaultPlanChoose oneObservation, since most hydroceles in infants resolve by 1 to 2 years of ageDefaultReferred to pediatric urology given a hydrocele persisting past infancyReferred to pediatric urology given a communicating hydroceleReferred to pediatric surgery for prompt repair of an inguinal herniaScrotal ultrasound ordered to see the testisSame-day scrotal Doppler ultrasound ordered given pain, to exclude torsion or epididymitisScrotal ultrasound ordered given a new hydrocele in an older childDispositionChoose oneSent to the emergency department given a firm groin bulge that does not reduceFollow-upChoose oneat the next well child checkDefaultin 3 monthsafter the ultrasoundafter the specialist visitas neededFollow-up reasonChoose anyJoins the line aboverecheck the hydroceleCounseling paragraphChoose oneParagraphHydroceles are common in infants, are not painful, and usually go away on their own by 1 to 2 years of age; the swelling may look bigger after crying or by the end of the day. No treatment is needed other than watching the size of the swelling. Return precautions given including a hard, painful, or red swelling, a bulge in the groin that does not go back in, vomiting, fussiness that cannot be consoled, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.DefaultA hydrocele that persists, changes size, or appears in an older child is checked by the specialist or an ultrasound, since some need a small surgery to close the opening. Return precautions given including a hard, painful, or red swelling, a bulge in the groin that does not go back in, vomiting, fussiness that cannot be consoled, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.An inguinal hernia in a young child is repaired soon, since bowel can get trapped in it. A bulge that becomes firm, painful, or red, or does not go back in, needs care right away. Return precautions given including a hard, painful, or red swelling, a bulge in the groin that does not go back in, vomiting, fussiness that cannot be consoled, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.Pain with scrotal swelling needs an ultrasound today to make sure the testicle is not twisted. Return precautions given including a hard, painful, or red swelling, a bulge in the groin that does not go back in, vomiting, fussiness that cannot be consoled, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.CounselingNot in the note with these choicesDiscussed the need for emergency evaluation today. Caregiver expressed understanding and agreement with plan. Answered all questions.What the sources coverSimple; communicating; hernia concern; testis not feltPain or tenderness; irreducible bulge present or absentObservation until 12-18 monthsUrology referral (persistent, communicating); surgery for hernia; ultrasoundEmergency department for an irreducible bulgeFollow-up next well check, 3 months, after ultrasound or specialistReturn precautions in the templatea hardpainfulred swellinga bulge in the groin that does not go back invomitingfussiness that cannot be consoledSourcesPediatric Care Online: Scrotal Swelling and PainHealthyChildren.org: Communicating HydroceleAAP Clinical Report, Assessment and Management of Inguinal Hernia in Infants (2012)Few formal guidelines cover this topic, so the template also leans on expert opinion.