Case 1 - Bella
- You are a clinician working in an emergency department in Queensland.
- You are about see a 6 month old female called Bella who was brought in by her father Derek and mother Priya. They presented as they were concerned that Bella was unwell.
- Observations: RR: 35 O2: 98% T: 37.2 HR: 130
- You have been asked to assess Bella and discuss your findings with the senior emergency department doctor.
Questions to discuss about Bella’s case
- What aspects of paediatric history taking and examination differ from adults? Consider features that would make you concerned that Bella is unwell/toxic.
- What birth history should you consider taking? Consider what is ‘term’ and complications of prematurity to consider.
- How should you approach the situation if Bella’s parents shared that her vaccinations are not up to date and would like to talk about it further?
- How would you assess Bella’s hydration status?
- What tool(s) may help you assess Bella’s pain? Consider options for neonate, 6 year old and 10 year old.
- What would be your approach to managing Bella’s pain in the emergency department?
- What is a primary survey?
Normal range for vital signs by age
| Age | Heart rate (bpm) | Minimum Systolic BP (mmHg) | Respiratory Rate (bpm) |
|---|---|---|---|
| <1 year old | 100-159 | <75 | 21-45 |
| 1-4 year old | 90-139 | <80 | 16-35 |
| 5-11 year old | 80-129 | <85 | 16-30 |
| 12-17 year old | 60-119 | <90 | 16-25 |
Case 2 - Stephanie
- You are a clinician working in an emergency department in Queensland.
- You are about see a 14 year old female called Stephanie who was brought in by her father Tarek and mother Freya. They tell you the reason they presented was that Stepahnie has abdominal pain.
- Observations: RR: 14 O2: 100% T: 37.4 HR: 90
- You have been asked to assess Stephanie and discuss your findings with the senior emergency department doctor.
Questions to discuss about Stephanie’s case
- What are some healthcare considerations given your patient is an adolescent?
- What are some additional considerations when you come to perform your examination?
- What is the approach to confidentiality in adolescents?
- Do parents/carers need to provide consent?
- What additional information should you consider asking in an adolescent history?
- Do you have a specific approach?
Normal range for vital signs by age
| Age | Heart rate (bpm) | Minimum Systolic BP (mmHg) | Respiratory Rate (bpm) |
|---|---|---|---|
| <1 year old | 100-159 | <75 | 21-45 |
| 1-4 year old | 90-139 | <80 | 16-35 |
| 5-11 year old | 80-129 | <85 | 16-30 |
| 12-17 year old | 60-119 | <90 | 16-25 |
Case 3 - Juan
- You are a clinician working in an emergency department in Queensland.
- The team leader receives a phone call from the Queensland Ambulance service (QAS) about a 2 year old male, Juan.
- Juan is being brought in unconscious with CPR in progress.
- QAS are 5 minutes away.
- No further information is available at this stage.
Questions to discuss about Juan’s case
- What are the key differences to consider in a paediatric resuscitation compared to adults? Consider role allocations.
- What are some of the anatomical, physiological, and psychological differences to consider in paediatric resuscitation when compared to adults?
- What weight (kg) would you estimate for Juan?
- What are the different ways of estimating a paediatric patient’s weight?
You have estimated Bella’s weight to be 12 kg. The team are starting to prepare drugs in anticipation for QAS.
- What is the appropriate method of determining resuscitation drug doses?
- Which drugs may be appropriate to prepare in this scenario?
QAS have arrived. CPR is ongoing. A pulse is not palpable. The monitor shows the following rhythm.
- What is this rhythm?
- How do you proceed?
Normal range for vital signs by age
| Age | Heart rate (bpm) | Minimum Systolic BP (mmHg) | Respiratory Rate (bpm) |
|---|---|---|---|
| <1 year old | 100-159 | <75 | 21-45 |
| 1-4 year old | 90-139 | <80 | 16-35 |
| 5-11 year old | 80-129 | <85 | 16-30 |
| 12-17 year old | 60-119 | <90 | 16-25 |