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Kiwiology

A Sick Child

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Can you convince her to look down at her bellybutton?

Want to evaluate her potential as a future stripper so they can reopen the Hooters on 29th? :D

Um, I guess you can

What else do people want to know, what are y'all thinking?

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OK, Mr. Scenario maker. Why do you think I want her to look at her bellybutton? And the Hooters was on 28th St.

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Because not being able to would be a symptom of meningeal inflammation duh

Edited by Kiwiology

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Or it might just be torticollis or plain ole neckpain.

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So the kid looks at her bellybutton. What happens?

Any illness in the familiy recently? Kid fussy, or kind of blah and wanting to hide?

Wendy

CO EMT-B

RN-ADN

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Could be anything. This is the most vague scenerio I've ever seen

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Consider the source, no offense but honestly, I can't understand half of what he's saying half the bloody time.

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Well I've tried to get more info, just got more questions. This scenero is no fun

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If you don't take the same prescription meds as he does , nothing makes sense.

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You are called to see a three year old female child at home. It is 11.30 pm and mum states her daughter has been unwell for approximately 16 hours since 8.00 am this morning when she woke her to go to pre-school.

HPI 16/24 generally unwell; has vomited once (stomach contents), no diarrhoea

O/A In bed, awake, alert, orientated for age, not in obvious distress. She prefers to be in bed with blankets over her

C/O “feels sick” – unable to be more specific

O/E

V/S: BP 100/70 PR 100 RR 40 T 37.5° SpO2 99% RA BGL 3.3 (~70) GCS 15

EXTREMITIES: Without cyanosis, clubbing or edema. Skin: WPD w/o purpura.

NEURO: NAD

HEENT: Denies sore throat, PERL (somewhat sensitive to pupillary light), otherwise NAD

NECK: Supple w/o lymphadenopathy.

CVS: NAD, normal S1/S2 w/o adventitious sounds

RESP: Air entry clear/equal, no adventitia, no cough

ABDO: Soft, non-tender, no distension, good bowel sounds. Inguinal area is normal.

Consider …

(1) What is your provisional diagnosis?

(2) Are there any “red flags” which you think this child needs immediate referral to a Doctor?

(3) If so, how quickly should she be seen by the Doctor upon arrival? Immediately? 10 minutes? 30? 60? 120?

(4) What treatment would you provide right now and why?

1. The DDx is so general at this point. It could be infections, poisoning, endocrine, etc.

2. The photophobia and respiratory rate are concerning. The BGL is a little towards the low side. This is 911, you call we haul.

3. Nothing to say this pt needs to be made a highest priority pt.

4. Rectal temp and more info from the mother

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