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18-8-2008
Pediatric Problem Solving – Case 7
An 18 months old boy came to the emergency department with rapid respiration, drowsiness. He had a history of vomiting and diarrhea for 3 days before the onset of his condition. By examination HR was 160, RR was 60, Temp. was 38.5 and Bp was 60/40. He had delayed capillary refill.
An 18 months old boy came to the emergency department with rapid respiration, drowsiness. He had a history of vomiting and diarrhea for 3 days before the onset of his condition. By examination HR was 160, RR was 60, Temp. was 38.5 and Bp was 60/40. He had delayed capillary refill.
What is the most likely action to be done?
A- Chest x-ray.
A- Chest x-ray.
B- Giving oral ttt and follow up.
C- Administration of IV fluids.
D- Blood gas analysis.
Explanation of the case:
key points:
Vomiting and diarrhea = ongoing losses of fluids and electrolytes, Increased HR (out of proportion with age and fever), RR, and decreased BP, DELAYED capillary refill= shock
Choice A :points against: it is an emergency + no need for it
Choice B :points against: it is an emergency
Choice C: (the right choice):points with: shock is an emergency with dramatic response to IV fluids
Choice D:points against: what happens clinically is (1) canula (2) take a blood sample (3) IV fluids. But we DO NOT wait for the results of blood gases, we start IV fluids at once, then if results show acidosis, we treat it.
Explanation of the case:
key points:
Vomiting and diarrhea = ongoing losses of fluids and electrolytes, Increased HR (out of proportion with age and fever), RR, and decreased BP, DELAYED capillary refill= shock
Choice A :points against: it is an emergency + no need for it
Choice B :points against: it is an emergency
Choice C: (the right choice):points with: shock is an emergency with dramatic response to IV fluids
Choice D:points against: what happens clinically is (1) canula (2) take a blood sample (3) IV fluids. But we DO NOT wait for the results of blood gases, we start IV fluids at once, then if results show acidosis, we treat it.
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