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Initial assessment continued

dehydration
0.1
So what we need to do now is obviously perform a bit more of a thorough examination. We have got a basic picture of what’s going on but we need to assess him in a bit more detail. So if you’re happy, I would like to have a listen to his lungs and see how that sounds. Then we’ll go through his tummy and see how happy he is with us doing that. Ok great. Do you mind just sitting him on your lap here? And turn him around, so I can listen to his back. Are you going to be a good boy? I’m just going to put this on your back? Make it nice and warm for you.
24.1
Yeh, wow, thank you very much.
36
Oh you’re doing really well. Can you take a big deep breath? Deep breath… Good boy… That’s a good breath. Wow that’s good. His chest sounds nice and clear.
55
Has he had a cough or a cold recently? No, he has not had a cough or cold. He’s had fever… What’s his oxygen saturation? His oxygen’s 100% and his temperature’s 38. Resp rate? Resp rate is 50. Heart rate? 140. Ok. We’ll do a quick blood pressure. Do you mind if I have a quick press of his tummy? Is that alright? Yes, please do. Can you spin him around? Ben, can I touch your tummy? Is is sore? Are you ticklish? No, can I have a quick touch of your tummy? Is that sore? Does that hurt? (Ben coughs) Oh wow. That’s a bit sore.
93.5
His abdomen is soft. There’s no rebound or guarding. Shall we cover you up? And Dad, I know you did mention, but how has his urine been? Has it been normal or has he been going a lot? It’s been pretty normal, possibly less than normal. Has he been excessively thirsty at all? I suppose he has been, yes. I notice that he is very dry around the mouth. Yes, it’s something I should’ve noticed before. Ben, can I have a quick look inside your mouth? Can we do that? Good boy, let’s have a quick look. Look at those teeth of yours. Wow. He got a very dry mucous membrane. And can I have a touch of your arm here?
135.9
Let’s have a quick look at this…
141.4
Ok. So he’s very warm, well perfused. Which is good. And have a quick touch here. How does his eyes like to you? Does he look normal or very tired? I suppose he’s getting a bit tired because he’s has this fever and vomiting and stuff. What was that blood pressure? It was 90/50 ok. So we got some tachycardic and he’s tachypnoeic as well, and pyrexic as well. And has he had any Calpol or Paracetamol or anything like that at all? Have you given him anything at all? No, no. That’s absolutely fine, no problem.

So what do you think Cam is getting at here? What is going through his mind as a possible diagnosis? Are there any key questions that Cam has asked that give the game away?

Have a think and share your thoughts with your fellow learners.

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Emergency and Urgent Care for Children: a Survival Guide

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