5 year old difficulty breathing

Arctan

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What about a Nasal Cannula? Wouldn't that help if his SpO2 is low?
 

DesertMedic66

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What about a Nasal Cannula? Wouldn't that help if his SpO2 is low?
If his SpO2 was low then sure it would probably help. However with everything going on with this kid, blow by oxygen is probably going to much better tolerated as nothing will be touching their face.
 

ChrisEMTA

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You are dispatched at 2am to a gated community residence. For a 5 year old difficulty breathing.

Fire is dispatched and gets there 15 minutes before you.
When you arrive on scene fire states the patient "looks crappy" and is "unhappy"

As you enter scene mother says child felt unwell today and "was hot" was sleeping in bed with her but did not have difficulty breathing until now. Patient is drooling and has some accessory muscle usage, clothes have been removed by mother prior to fire arrival. Pulse ox is 100% as fire have them on 15ltr, BP 92/60, HR 130, temp 102.6 Lungs clear and equal rate of 34 slightly shallow. Patient gaze tracks normally, responding appropriately. Good color albeit a bit red/flushed.

No past medical history, mother gave Tylenol on instruction from nurseline 4 hours ago. No issues.
Visualization of the mouth looks normal apart from some excessive drooling.


Children's specialty hospital 40 minutes west. Normal ER with OR in hospital 10 minutes east.
Ok late to this scenerio but also new to the forum so don't hold it against me. ABCs? SAMPLE? Place a IV start a litter of fluids for soft BP and fever= possible dehydration. Spo2 was good but there was some accessory breathing so run a nebulizer. Heart rate elevation is common with infections and dehydration is common with fever which soft or low BPs are common with dehydration so In conclusion IV fluids and a neb transport to closest ED. If airway is not being protected BVM and get paramedic to consider a RSI.
 

silver

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Ok late to this scenerio but also new to the forum so don't hold it against me. ABCs? SAMPLE? Place a IV start a litter of fluids for soft BP and fever= possible dehydration. Spo2 was good but there was some accessory breathing so run a nebulizer. Heart rate elevation is common with infections and dehydration is common with fever which soft or low BPs are common with dehydration so In conclusion IV fluids and a neb transport to closest ED. If airway is not being protected BVM and get paramedic to consider a RSI.
The patient is 5y/o. That BP is normal, and HR is maybe just a bit high. Would you give 1L of fluid?

If you think epiglottitis as others had mentioned, would you wait around to intercept with a paramedic to RSI?
Not so easy
 

johnrsemt

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HR is normal for a child with a temp that high; remember the average HR goes up 10-15 for every degree of temperature: (Took me a couple of years of being beat by my medics to remember that).
BP is good.

If you have a child that doesn't do nebulizer's well, ask them if their parents have taught them to smoke yet? when they respond no (and hopefully that is the answer), give them the handheld nebulizer and let them smoke it. It has worked great for me, except when it is time to take it away..
 

ChrisEMTA

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The patient is 5y/o. That BP is normal, and HR is maybe just a bit high. Would you give 1L of fluid?

If you think epiglottitis as others had mentioned, would you wait around to intercept with a paramedic to RSI?
Not so easy
I misread. I thought it said 15 at the time.
 

Tigger

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Ok late to this scenerio but also new to the forum so don't hold it against me. ABCs? SAMPLE? Place a IV start a litter of fluids for soft BP and fever= possible dehydration. Spo2 was good but there was some accessory breathing so run a nebulizer. Heart rate elevation is common with infections and dehydration is common with fever which soft or low BPs are common with dehydration so In conclusion IV fluids and a neb transport to closest ED. If airway is not being protected BVM and get paramedic to consider a RSI.
What indication is there for albuterol here?

Accessory breathing is not indication for albuterol.

Maybe an IV is indicated. BVMs don’t protect airways. RSI?!
 

ChrisEMTA

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What indication is there for albuterol here?

Accessory breathing is not indication for albuterol.

Maybe an IV is indicated. BVMs don’t protect airways. RSI?!
I re read the post because I have been mixing up a few things on this one. If no wheezing then no albeterol. Not sure why I said RSI. But I would expect to be suctions the airway if the drool starts to obstruct.
 

MrBrown

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I am bloody terrible at kids. I had almost zero clinical exposure to them. I wholeheartedly agree epiglottis though.

So, imagining the child is now in some form of extremis with a poor airway. The choices are (a) stay, (b) go to 10 minutes away big persons hospital, or (c) go 40 minutes to little person specialist hospital. I agree little people generally need a little people specialist. However, I would take the child to the 10 minutes away hospital with very early notification, like before leaving the house early. If it is 2 am this hospital could well have an ED staffed by a Registrar overnight with no on-site consultant, surgeon or anaesthetist. I make the point because this hospital has an operating theatre. Operating theatres come with anaesthetists. So, that is favourable. But, they are going to need to come in. Even if by good luck (more than anything I suspect) there is an on-site anaesthestic doctor, it is also likely to be a Registrar. I doubt they will have any experience in emergency airway management in small patients. They might ... but yeah, guessing not. So, pass hospital message very early so they can call in people.

Now, in saying this, if moving towards the small people hospital was moving toward backup that could come out such as paediatric retrieval team or ambulance doctor-based response then perhaps it makes more sense to go that way. Dare I say, and perhaps of a Strawbridge argument, is an air-based response coming toward us as we move toward them? Assuming an appropriate clinical crew (really thinking a doctor) is with the machine and they can fly at night (not all can), and we were travelling along somewhere the Fire Brigade could close the road or something then assuming it takes 5 minutes to get off the ground and maybe 5-10 minutes to fly and land, then that is probably better than going to the close hospital. I would, however, want to have a short but very focussed discussion with the helicopter crew before deciding to leave the scene and head away from the close hospital.
 
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