Hamilton CME

Pediatric Case Presentation

Spring 2008

Case Intro

8 y.o. SOB Visiting family farm Playing with cousins Unknown mechanism

Case Intro

Severe dyspnea Head-bobbing Tired / lethargic

Differential Diagnoses?

Primary Assessment

“can’t breathe” Tachypneic WOB Very little AE

Primary Assessment

• Weak, thready carotid pulse• Pale ++, dry skin ++• Eyes open to voice• Confused• Obeys commands

Focused History

Playing “hide & seek” Found SOB ++ MDI medications = no relief Asthmatic history

Focused Examination

Focused Examination

AE Accessory muscle use Retractions Paradoxical breathing

Working Diagnosis?

Treatment Options

PCP– Airway– Breathing– Circulation– Drugs– Extra Care

ACP– Airway– Breathing– Circulation– Drugs– Extra Care

Enroute

Enroute

Teaching Point

Teaching Point

References

1. Emergency Medicine: A Comprehensive Study Guide - 6th Ed•PEDIATRIC ASTHMA AND BRONCHIOLITIS - Maybelle Kou, Thom Mayer