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Hamilton CME
Pediatric Case Presentation
Spring 2008
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Case Intro
8 y.o. SOB Visiting family farm Playing with cousins Unknown mechanism
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Case Intro
Severe dyspnea Head-bobbing Tired / lethargic
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Differential Diagnoses?
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Primary Assessment
“can’t breathe” Tachypneic WOB Very little AE
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Primary Assessment
• Weak, thready carotid pulse• Pale ++, dry skin ++• Eyes open to voice• Confused• Obeys commands
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Focused History
Playing “hide & seek” Found SOB ++ MDI medications = no relief Asthmatic history
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Focused Examination
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Focused Examination
AE Accessory muscle use Retractions Paradoxical breathing
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Working Diagnosis?
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Treatment Options
PCP– Airway– Breathing– Circulation– Drugs– Extra Care
ACP– Airway– Breathing– Circulation– Drugs– Extra Care
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Enroute
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Enroute
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Teaching Point
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Teaching Point
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References
1. Emergency Medicine: A Comprehensive Study Guide - 6th Ed•PEDIATRIC ASTHMA AND BRONCHIOLITIS - Maybelle Kou, Thom Mayer