Infant abuse and the angry team member

Scenario overview A 10-month-old infant is brought in by his mother because “he's not acting right.” He has had 2 days of symptoms of an upper respiratory tract infection (URI) and fevers, but since last night he has been sleeping more, not eating well and has no wet diapers for over 6 hours. The father cares for the patient at night while mother is at work and he works days. When the mother got home today she found the baby acting this way. She has given acetaminophen and tried to get the baby to eat and eventually came to ED. The patient is “lethargic” and responds very weakly to being examined and to painful stimulation by the team. The patient has tachycardia, delayed cap refill (3-4 seconds) and weak peripheral pulses. When the patient is rolled or if the back is examined, there are a bruises on the back and buttocks. During the course of the examination, one of the nurses will be become increasingly “upset” because of the child's abuse. Initially she is aloof and not communicative with the mother. But when the father comes in and it becomes clear that he is the abuser, she should become increasingly more hostile to the father and eventually initiate an actual fight or verbal altercation with the father.