Pediatric Problem Solving -Case 5

Pediatric Problem Solving – Case 5
A 12 years old female came to hospital with fever, difficulty in breathing, severe effort intolerance and joint pain which started in the rt. wrist and later involved the lt. knee. By examination BP was 90/60, HR was 140, RR was 35 and Temp. was 39 c. Abdominal examination revealed enlarged tender liver.
The first action to be done
A- Starting antifailure treatment

B- NSAID administration

C- IV fluid administration

D- Blood culture
Explanation of the case
Key points
1. 12 years old + fever + Joint pain (large joints) + pain moves from joint to joint = most probably rheumatic fever.
2. HR 30 beats per min more than normal (HR is affected by both temperature and age, in this case age is 12, so HR is supposed to be 90/min, the temperature is 39, so it is supposed to increase HR 20/min. )
3. Tachypnea (normal RR is 20 in this age).
4. blood pressure is within normal, but we do not depend on this sign in children from 2, 3 and 4, patient is having heart failure (an emergency)
so we have to start antifailure ttt = diuretics, digoxin..etc..
 Choice A: (the right choice
 Choice B: points Against: we are not sure of diagnosis + we've to start antifailure ttt before anything else