Kiwiology Posted December 23, 2009 Author Share Posted December 23, 2009 Allergies? If so, to what? And has the kid been exposed? Allergies? If so, to what? And has the kid been exposed? No and no. ALS (MICA) has been redirected to a cardiac arrest, a solo responder is being recalled from the city to come out. His ETA is six minutes. The hospital is 15-20 minutes away. Link to comment Share on other sites More sharing options...
Timmy Posted December 23, 2009 Share Posted December 23, 2009 So we have a 4 yo in sev resp distress, Phx of croup, SP02 in the 80's, tachypneic, cyanosis, nill know allergies, your indicating its not asthma and not anaphylaxis. What was the kid doing when the symptoms began? Has he been unwell lately? On any meds? Link to comment Share on other sites More sharing options...
melclin Posted December 23, 2009 Share Posted December 23, 2009 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. Man the ROFL copters, we have incoming LOL. hehehe, golden. Link to comment Share on other sites More sharing options...
mobey Posted December 23, 2009 Share Posted December 23, 2009 Any swelling of the face or hands? Is the kid drooling? Temp? Any urticaria? If the kid is blue and low 80's I am going to be pretty quick to intubate. We can start a racemic Epi neb, but I am not convinced it will have any effect. Lets start the neb and load up. I would probably intubate in the ambulance. What are the air entry sounds in the lung fields? Link to comment Share on other sites More sharing options...
tniuqs Posted December 23, 2009 Share Posted December 23, 2009 (edited) Any swelling of the face or hands? Is the kid drooling? Temp? Any urticaria? If the kid is blue and low 80's I am going to be pretty quick to intubate. We can start a racemic Epi neb, but I am not convinced it will have any effect. Lets start the neb and load up. I would probably intubate in the ambulance. What are the air entry sounds in the lung fields? <Late edit> BS Rasping cough, high pitched stridorous sound insp/exp, sounds diminished in all fields Hmmm interesting ? Nice what are we hearing .. back to a systematic evaluation and attempting to eliminate a "few" other underlying possible pathologies first ?If this is a BLS crew ... get the ass enroute, perhaps an information patch to ER ???? Have FF remove frantic "teacher" and show her the big red truck .. take the rest of the class too, heck might as well promote the Fire Service .... The ONSET of the symptoms may be a hint of what may happening, was this sudden onset or was this kid sick when he showed up at the child care facility ? And if one choses to jump on the "inhaled meds" SVN (what is the scope of practice on site if ALS was enroute and then diverted?).. with sats of 80 would "tusks" be a good idea ? Ok I will take a pretty picture for yall dumb ass Paraidiots ... So Epi has been suggested (this kid is already stressed) would anyone want to go the salbutamol or atrovent or even inhaled steroids route first ? cheers Edited December 23, 2009 by tniuqs Link to comment Share on other sites More sharing options...
streethealer535 Posted December 23, 2009 Share Posted December 23, 2009 What are the 02 Stats? REALY???? tell me please that this was a typo or a joke.... if its a joke I get it and yes you got me.... if not then well please just shoot me now... ~Street Link to comment Share on other sites More sharing options...
Kiwiology Posted December 23, 2009 Author Share Posted December 23, 2009 Any swelling of the face or hands? Is the kid drooling? Temp? Any urticaria? No Afebrile No You try 5mg nebulised adrenaline to no effect. Link to comment Share on other sites More sharing options...
chbare Posted December 23, 2009 Share Posted December 23, 2009 <Late edit> BS Rasping cough, high pitched stridorous sound insp/exp, sounds diminished in all fields Hmmm interesting ? Nice what are we hearing .. back to a systematic evaluation and attempting to eliminate a "few" other underlying possible pathologies first ?If this is a BLS crew ... get the ass enroute, perhaps an information patch to ER ???? Have FF remove frantic "teacher" and show her the big red truck .. take the rest of the class too, heck might as well promote the Fire Service .... The ONSET of the symptoms may be a hint of what may happening, was this sudden onset or was this kid sick when he showed up at the child care facility ? And if one choses to jump on the "inhaled meds" SVN (what is the scope of practice on site if ALS was enroute and then diverted?).. with sats of 80 would "tusks" be a good idea ? Ok I will take a pretty picture for yall dumb ass Paraidiots ... So Epi has been suggested (this kid is already stressed) would anyone want to go the salbutamol or atrovent or even inhaled steroids route first ? cheers I agree with the additional history and assessment considerations. For example, sudden onset stridor is going to have different pathology considerations. I would most likely not go with salbutamol for an upper airway obstruction problem such as this kiddo. I would want to consider something like racemic epinephrine and ensure we are nebulising this medication properly, because unlike salbutamol, we want inertial impaction and deposition of the aerosol in the upper airway. I would agree, that at least a loading dose of a steriod will be indicated in this patient. While not an EMS consideration, this patient may benefit from Heliox therapy. If we are still looking at croup, I would not consider antimicrobial therapy unless we have other indications of a bacterial infection. We must remember, croup is typically a viral infection. Take care, chbare. 1 Link to comment Share on other sites More sharing options...
scott33 Posted December 23, 2009 Share Posted December 23, 2009 There is still something that needs to be ruled out (albeit in double-quick time). Link to comment Share on other sites More sharing options...
chbare Posted December 24, 2009 Share Posted December 24, 2009 A foreign body obstruction should be ruled out, hence obtaining additional history if possible. Take care, chbare. Link to comment Share on other sites More sharing options...
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