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Height + weight = practical challenge

So we need to reassess the observations now. After we gave him nebuliser we need to double check the obs. He’s got saturation levels of 90 percent. And he is tachy at 175. His temperature is 39.4. Resp rate is 48. He is now pain on the AVPU scale. I think we need to seriously consider moving and getting him down.

The crew have reassessed Marley and he has deteriorated. In particular he has now moved from V to P on the AVPU score. They have decide that it is more likely that he is suffering from a chest infection than an asthma type problem and and have recognised that he fits the big sick category for a number of reasons; low oxygen saturations, respiratory distress with tachypnoea and grunting, mild recession but no prolonged expiration. The nebuliser has made no difference and he is now more unwell; in particular his heart rate has increased and he is less responsive. The crew are clearly thinking that he is showing signs of shock and decide to move him to the ambulance.

In some cases it’s really easy to notice a shocked patient, they look really sick, they’ll be tachycardic, they’ll be tachypnoeic, they’ll be pale, they’ll be sleepy. Anyone who seen a few children will look at these features and immediately realise that the child is really sick. But in the early stages things can be a bit less clear cut than that, so a hot child can be tachycardic and tachypnoeic they could be miserable, they could be tired and sleepy. That maybe early stage of sepsis of it may just all be a manifestation of them being pyrexial.

The important thing is, when faced with children like this, that you keep an open mind. Don’t assume that the signs are due to fever, but if the child is stable enough to let you do so, test the hypothesis by trying to bring the fever down and then reassess. You’ve always got to be alert to the possibility that your tachycardic or tachypnoeic child could actually be at the early stages of something more significant. And being alert to the possibility means that you’re not going to be miss the child who either doesn’t get better or deteriorates. .

Remember blood pressure will be normal in a septic child and until they become really unwell but if the blood pressure is low, you really have got to be considering that his child has the signs of sepsis and get on the start to treat. 

So back to Marley:

  1. What do you think the most likely diagnosis is at this stage?
  2. Simple question… Marley is tall for his age and very sporty. He weighs 36 kilos… how would you get him down from the high sleeper bed? We have been wondering about this ourselves and would be really keen to find out what you would do!
  3. What procedures do you think the crew will undertake once they get him to the ambulance?
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Emergency and Urgent Care for Children: a Survival Guide

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