Day 1- Pediatric Emergency Room

Day 1- Registered into the hospital. Meet the Dr that I will follow. Note 1- patient with fever and leukocytosis-always do an x-ray to check for pneumonia! In this case, this patient had pneumonia which could be seen as infiltration in the left lobes surrounding the left bronchus. This made the left bronchi show up in the x-ray which it usually does not. Simulation- Patient-11 months old, fever 2 days 39C and 40C what to do? 1st take the pulse and vitals: pulse 197 BPM 4 second capillary reflex low energy crying Suggested by student: 1)intramuscular injection of antibiotics because there was no IV access 2)20cc/kilo bolus fluid injection patient continues with tachycardia at 184 BPM Suggested by student: 1) another bolus and a half of fluids Child still in shock Need to start inotropic therapy-several options 1. dopamine drip 1ml/hr=1cm/k/min 3mg x body weight in 50ml dsl. Dopamine with fluids---interosseous/IV (((((passed the 15 minute mark)))))) --------------------------- We were waiting for a bed in ICU while the nurse calls out that the saturation is continuing to drop to 65% and pulse is 180, unresponsive and stopped breathing. ~Grab 02mask and start pumping. --------------------------- This child had septic shock. With septic shock it is important to take note of the general appearance, no perfusion = no saturation, mental status, breathing. These conditions are septic shock until proven otherwise. Management of septic shock: 1. Get IV access in the 1st 60 seconds. if no IV- IO medial side of tibia. 2. give 02 Things to consider: ~Central line will take 20 min, so no point! ~IO needle automatic or manual...manual has higher success rate-feel it reaching the bone and not jerk back when shot by automatic (like a gun) AIR-access, intervene, re-access We should have given 2 or even 3 pushes of 20cc/kilo of fluids. ~Dopamine will take 10 min Fluid resistent shock- give inotropic 1. dopamine or 2. Norepinephrine not dobutamine or not imidarone (loading dose drops BP) Dopamine for cold shock NE for warm shock GENERAL GUIDELINES: 15 min: dopamine, iv, 2 bolus 30 min; ICU and let them know u have a patient ready to be transferred Septic shock is a killer but can be easily cured if you know the necessary steps. Rapid sequence intubation Intubation- use medazolam for calming sedation- katomine, vicronion, panceum, esmoran parylsysis- intubation to finish what started. polarizing:pancreamium depolarizing:succineal choline causes hyperthermia and metobolic disorders