Help with Scenario would it be respiratory case or shock need some advice

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Shot32159

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You are called to a 3 yo girl with a 2 day history of vomiting and diarrhea. The first time she vomited
unassisted in her bed, waking her from her sleep. This morning she spiked a fever of 39.2 C. So Mom called 911. You find the baby lying on the couch lethargic and restless. She does not recognize that you are there. Her airway is open and maintainable. Her RR is 40 and shallow. She has mild subcostal
retractions. You hear crackles in her lung bases. Her HR is 140. Her Spo2 is 89%. Her capillary refill
time is 7 sec. Her skin is
pale, dry, and warm. Her BP is 70/50. Her eco2 is 35.

Based on the PEARS assessment criteria, evaluate and treat this child.
 
Carlos Danger

Carlos Danger

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What is PEARS assessment criteria?
 
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Shot32159

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Pediatric Emergency Assessment, Recognition, and Stabilization
 
Ewok Jerky

Ewok Jerky

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I dont know about PEARS but this meets SIRS criteria and smells like sepsis. I would be worried about end organ damage. Prehospital treatment includes a bunch of fluid and a ride to the nearest pedi center. Get an accurate temp. Considering end organ damage i may run a 12 lead but not hifh in the priority list. If you can draw labs en route do that. Would love to know if she is acidotic and making urine or not.

Has she been making wet diapers?
Last time she was A&Ox3?
Previous respiratory illness?
Any surgical Hx?
Do we have an SpO2?
Heart sounds? Signs of failure?
 
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Carlos Danger

Carlos Danger

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Sorry, but I don't know anything about PEARS....

Could be sepsis, could be aspiration. Could be both. Could be other things, too. Not enough info to diagnose.

Based on the vomiting, Sp02, and, wheezes, I'd say Mendelson's syndrome, as well as severe dehydration from the original GI problem.

- Oxygen
- IVF
- Check glucose
- Transport
 
NomadicMedic

NomadicMedic

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Agreed with all of the above. Kiddo needs fluid and probably some D10. Depending on the length of transport, work of breathing and level of exhaustion, this kiddo will also need some additional respiratory support.
 
ERDoc

ERDoc

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This poor kid is septic. It could be aspiration pneumonia or it could be due to the issue that caused the vomiting. What is her abd exam? I'm leaning more towards aspiration pneumonia given the sats and lung exam. A 3y/o that doesn't get scared when a bunch of strangers come into her house should scare the hell out of you.
 
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pcagnard294

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Definitely a sepsis case based on pears the pt would be critical and I would have ALS on the way or on my way to nearest pediatric receiving based on ALS eta.
 
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