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The team arrive to find a challenge in more ways than one…

Hi. Hello, we’re from the Ambulance Service. Right this way. It’s my grandson. Thank you.
Ok, so can you tell us what’s been happening? So for the last 24 hours, he’s been, he’s breathing has been laboured. I’m really worried about him now. Hi Marley, can you hear me? He seems quite breathless. Ok so for 24 hours he’s been unwell? He’s been unwell. He’s short of breath recently. Yes. Has he had any diarrhoea or vomiting recently? No, no its nothing like that. Just the breathing. Has he had a cough recently? No he’s been perfectly healthy.
Any past medical problems that you’re aware of? He’s fit and healthy in every way. Is he allergic to anything that you know of? No. He doesn’t take any regular medications? No.
Oxygen levels are 89 percent. Ok. And he’s ‘voice’ is on the AVPU scale.
His temperature is 40.2. (Marley continues to grunt and struggle with his breathing) Resp rate is currently 40.
BM is 5.2.
Ok so we’ve got oxygen level of 89 percent. He’s tachy at 120. He’s a ‘V’ on the AVPU. And BM is 4.2. I’ve listened to his chest as well. He has reduced air entry on the left hand side and wheeze on the right hand side.

In this short clip, we sees the paramedics arriving at the scene where there is a poorly looking Marley. Unfazed by the access issues, the paramedics perform an initial assessment which shows that Marley has a patent airway, he is grunting with saturations of 89% in air, he has reduced air entry on one side of the chest and wheeze on the other, and he is tachycardic. He is also pyrexial.

  • We have used the term ‘grunting’. What do we mean by grunting and what is happening when a child grunts?
  • From what you have seen in this short clip what do you think is going on here and what are your immediate priorities?
  • What practical problems do you anticipate in his management and what suggestions do you have to how you would overcome them?
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Emergency and Urgent Care for Children: a Survival Guide

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