Kiwiology Posted December 23, 2009 Share Posted December 23, 2009 If you have participated elsewhere please don't spoil. You are sent to a prision for children who's parents are out chasing the Capitilist dream daycare centre for a child with severe life threatning croup and a history of same. Hospital is 20 minutes, Intensive Care/ALS is following, ETA is 8 minutes. Response time is 6 minutes. Link to comment Share on other sites More sharing options...
aussiephil Posted December 23, 2009 Share Posted December 23, 2009 hmmm brain strain. Is there stridor? Intercostal recessions? Is it croup? especially through the middle of the day. Oh snak kiwi. Maybe I am onto something. Link to comment Share on other sites More sharing options...
Kiwiology Posted December 23, 2009 Author Share Posted December 23, 2009 (edited) You arrive to find eight firefighters already on scene in all thier getup, 6 are standing around doing nothing, 1 is attempting a blood pressure and the other is trying to turn the oxygen on. Oh wait wait wait, what am I saying, we think logically down here, so scratch that, they're back at the fire station where they belong watching telly and playing scrabble. Patient is a 4 year old male in severe resp distress. BP 110/P RR 30, laboured, sig increased work of breathing, acc. muscle use (back/neck/trachea/costals) PR 130 BS Rasping cough, high pitched stridorous sound insp/exp, sounds diminished in all fields The teacher keps on screaming about how the parents said he has a history of severe, life threatning croup. This is a real job, I am interested to see how we approach it. Edited December 23, 2009 by kiwimedic 1 Link to comment Share on other sites More sharing options...
Timmy Posted December 23, 2009 Share Posted December 23, 2009 (edited) Get on the dog and bone and tell MICA to put the foot down or you initiate transport, no time to waste here! What are the 02 Stats? Any cyanosis? Treatment really depends on the severity but I'm treating for worse case here, based on your primary assessment. Assisted ventilations. IMI Dexamethasone. If needed you'll need to pop down an ET tube. Edited December 23, 2009 by Timmy Link to comment Share on other sites More sharing options...
scott33 Posted December 23, 2009 Share Posted December 23, 2009 IMI Dexamethasone. Why? Link to comment Share on other sites More sharing options...
Timmy Posted December 23, 2009 Share Posted December 23, 2009 (edited) The kid obviously has an upper resp tract infection with localised oedema and by going with what Ben has portrayed in his assessment the kid is pretty sick. By giving a corticosteroid (i.e.Dexamethasone) your reducing the inflammatory response, reducing the need to intubate the kid and Dexamethasone has an optimal discharge rate in presentations of sever croup with a decrease in re presentation of symptoms. Obviously you need to check of other reasons (Asthma, obstruction etc) but I'm taking it the kid has croup? Edited December 23, 2009 by Timmy Link to comment Share on other sites More sharing options...
Kiwiology Posted December 23, 2009 Author Share Posted December 23, 2009 Get on the dog and bone and tell MICA to put the foot down or you initiate transport, no time to waste here! MICA (ALS) are battling traffic, they have a three minute ETA; would you like some Firefighters instead?, they are getting bored watchin telly and playing boggle. What are the 02 Stats? ~ Low eighties Any cyanosis? More than you can shake a stick at Assisted ventilations. The patient is still breathing at the moment Why [iM Dexamethasone]? Yeah, why, want some Ceftriaxone too? Link to comment Share on other sites More sharing options...
scott33 Posted December 23, 2009 Share Posted December 23, 2009 The kid obviously has an upper resp tract infection with localised oedema I think you should be assessing a little more before treating. What have you managed to rule out, based on what little you have been told, to arrive at a diagnosis of a URI? Link to comment Share on other sites More sharing options...
Kiwiology Posted December 23, 2009 Author Share Posted December 23, 2009 (edited) The kid obviously has an upper resp tract ...localised oedema... What do we normally do for laryngeal edema? Like we've said, this kid is pretty crook. Is there anything else you want to do, or ask the teacher? Edited December 23, 2009 by kiwimedic Link to comment Share on other sites More sharing options...
Timmy Posted December 23, 2009 Share Posted December 23, 2009 (edited) Allergies? If so, to what? And has the kid been exposed? Edited December 23, 2009 by Timmy Link to comment Share on other sites More sharing options...
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