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Pediatric Emergency: Sick Child Dispatched to 825 E. Augustus St.

This emergency dispatch involves a sick child at 825 E. Augustus St. The child, a 16-month-old with a 102-degree fever, is not behaving normally. Follow the scene size-up and initial assessment protocols to provide immediate care.

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Pediatric Emergency: Sick Child Dispatched to 825 E. Augustus St.

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  1. Pediatric Call

  2. Dispatched to 825 E. Augustus St. for a sick child. Dispatcher relays that the patient is conscious and breathing.

  3. Part I SCENE SIZE-UP • Defined: • Begins with dispatch • We are instructed to go to the side of the house to the garage which faces Blackford Blvd. We know that Augustus is a one way street going West so we are going to have to go to 14th street where it intersects with Blackford Blvd. and take it South to the residence.

  4. Initial evaluation of the scene • Enter Slowly • Observe for safety and mechanism of injury • Goals: • Ensure scene safety • Remember you are going to observe as you approach and before you get out of the vehicle • To determine if patient is medical or trauma • If no mechanism of injury, obtain c/c and ask if any injury has occurred. Mom is holding the child in her arms and tells us her 16 month old son has just not been acting himself, has not been eating or drinking much and has a fever of 102. • Determine total number of patients • Simply ask if anyone else is injured or ill and needs medical attention

  5. Part II INITIAL ASSESSMENT • Defined: • Discovering and treating life-threatening conditions • PRIORITY PATIENTS: Poor General Impression Unresponsive or listless Does recognize parents or primary care givers Not comforted when held by parent but becomes calm and quiet when set down Compromised airway Respiratory arrest or inadequate breathing Possibility of shock Uncontrollable bleeding Goals: • Determine if the patient is ill or injured Ill child • Triage One ill 14 month old male

  6. Part II INITIAL ASSESSMENT • Components: • General Impression • Illness or injury- -Ill • Mechanism of injury/Nature of illness- -Fever • Age, sex, race- -16 month white male • Identify life-threatening problems • Well or sick • Ill • Mental status • drowsy • sleepy- -appears to be • inattentive- -appears to be • Mental Status • A lert V erbal Response P ainful Response U nresponsive • Should turn and look or look at you when addressed • Should follow simple commands

  7. Part II INITIAL ASSESSMENT • Assess Airway • Depressed mental status- -Yes as he does not respond to your presence or your voice • Secretions- -No • Blood- -No • Vomits- -No. Inquire as this is a pertinent negative • Trauma- -No • Infections- -Inquire as this is a PMHx. As well as a pertinent negatige. • Do not hyperextend neck • Assess Breathing • Effort of breathing- -Rate and quality • Chest expansion • Effort of breathing • Sounds of breathing • Breathing rate • Color • Oxygen therapy • Blow by method

  8. Part II INITIAL ASSESSMENT • Skin color • Pale- -Yes • cyanotic • flushed- -Yes • Quality of speech • Strong cry- -Silent • Speak only in short sentences • Meaningful gibberish grunts • Interaction with the environment or others • Silence- -Quietly in Moms’ arms • Listlessness- -yes • Unconscious- -no • Emotional state • Withdrawn- -No • Emotionally flat- -Yes • Response to you • Inattention to strangers- -Seems to care less that you are there

  9. Part II INITIAL ASSESSMENT • Tone and body position • Limpness- -No, not a rag doll or unable to hold head up • Poor muscle tone- -No • Position to indicate respiratory distress- -No

  10. Part II INITIAL ASSESSMENT • Assess Pulse/ Circulation- -Rate and quality • Circulation • Skin color • Pulse • Radial in child • Brachial or capillary refill for infants or child <5 • Triage One ill child

  11. Part III Focused History and Physical Exam • Defined: • To identify additional serious or potentially life-threatening injuries or conditions Fever- -febrile to touch Listless- -not too active, quiet in moms’ arms Has not had much to eat or drink

  12. Part III Focused History and Physical Exam • Components, Trauma • Reconsider Mechanism of injury • Index of suspicion • Rapid Trauma Assessment • Head to toe physical exam quickly conducted • Base-line Vital Signs • Assess S A M P L E history Not A Trauma

  13. Part III Focused History and Physical Exam • Components Medical • History of present illness • O – P – Q – R – S – T • Onset- -noticed didn’t eat much for supper last night, • fever this morning and not been playful. • Provocation- -None • Quality- -fever is high enough to manifest definitive signs • and symptoms • Radiation- -Always inquire if there is or seems to be any • Pain • Severity- -Listless, non-responsive, pale and flush • Time- -Overall time he’s had the fever • Interventions- -What has mom done? Tylenol etc.

  14. Part III Focused History and Physical Exam • S A M P L E • S/S- -as determined and observed • Allergies- -None • Medications- -None • PMHx- -prone to ear infections, URI etc. • Last oral intake- -Important to ascertain when and how • much he’s had to eat and drink • Inquire as to his diaper changes and how wet • Rapid Assessment- -Feel forehead and chest • Base-line Vital Signs • B/P- -under 3 yrs. So not takes • Pulse- -128 • Respirations- -30 • HIGH NORMS • Treat • Blow-by O2 • VS • *Transport

  15. Part III Focused History and Physical Exam • IF UNRESPONSIVE: • Rapid Assessment • Base-line Vital Signs • Assess S A M P L E • Care Not Unresponsive

  16. Part IV Detailed Physical Exam • In this case, probably not necessary. • Defined • Head to toe physical exam that is performed slower and in a more thorough manner that the rapid assessment • Components • Head to toe • Reassess vital signs • Continue care- -Repeat Vital Signs

  17. Part IV Detailed Physical Exam • Toe-to-head exam with infants and small children • Unless injury/illness won’t permit, allow • parent to hold child in lap • Shelter from stares and onlookers • Children loose heat quickly so recover quickly after exposing for exam

  18. Part V On-Going Assessment • Defined: To detect any changes in the patient’s condition To detect any missed injuries or conditions To adjust care as needed • Goal: The initial assessment is repeated Vital signs are repeated and recorded Focused assessment repeated for additional complaints

  19. Part V On-Going Assessment • Components: • Repeat Initial Assessment • Discovering and treating life-threatening conditions • PRIORITY PATIENTS: Has this changed • General Impression • Illness or injury • Mechanism of injury/Nature of illness • Age, sex, race • Identify life-threatening problems • Well or sick • Ill • Mental status • drowsy • sleepy- -appears to be • inattentive- -appears to be • Mental Status- -Any significant changes • A lert V erbal Response P ainful Response U nresponsive Should turn and look or look at you when addressed Should follow simple commands

  20. Part V On-Going Assessment • Assess Airway • Depressed mental status- -Yes as he does not respond to your presence or your voice • Secretions- -No • Blood- -No • Vomits- -No. Inquire as this is a pertinent negative • Trauma- -No • Infections- -Inquire as this is a PMHx. As well as a pertinent negatige. • Do not hyperextend neck

  21. Part V On-Going Assessment • Assess Breathing • Effort of breathing- -Rate and quality • Chest expansion • Effort of breathing • Sounds of breathing • Breathing rate • Color • Assess Pulse/ Circulation- -Rate and quality • Circulation • Skin color • Pulse • Radial in child • Brachial or capillary refill for infants or child <5

  22. Part V On-Going Assessment • Skin color • Pale- -Yes • cyanotic • flushed- -Yes • Quality of speech • *Strong cry- -Silent • Speak only in short sentences • Meaningful gibberish • grunts • Interaction with the environment or others • *Silence- -Quietly in Moms’ arms • *Listlessness- -yes • Unconscious- -no • Emotional state • Withdrawn- -No • *Emotionally flat- -Yes • Response to you • *Inattention to strangers- -Seems to care less that you are there • Tone and body position • Limpness- -No, not a rag doll or unable to hold head up • Poor muscle tone- -No • Position to indicate respiratory distress- -No

  23. Part V On-Going Assessment • Repeat focused assessment • To identify additional serious or potentially life-threatening injuries or conditions • Fever- -febrile to touch • Listless- -not too active, quiet in moms’ arms • Has not had much to eat or drink • Repeat Vital Signs • Check interventions • Note trends in patient condition • Changes can occur quickly and dramatically. Don’t take your eyes off of this child for a second

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