Case-based discussions: Module 1 - Introduction to paediatric emergency medicine

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.

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 based on Childhood Early Warning Tool (CEWT)
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

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.

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 based on Childhood Early Warning Tool (CEWT)
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

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.

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.

QAS have arrived. CPR is ongoing. A pulse is not palpable. The monitor shows the following rhythm.

Heart rhythm case-3

Normal range for vital signs by age based on Childhood Early Warning Tool (CEWT)
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