You are working as a double Technician crew on an ambulance when you are called to a 3-year-old who has had a prolonged fever and is not responding appropriately. On arrival at scene, you are shown in to the patient where he is laying on the floor. He only has a nappy on, seems to have an erythema rash over his chest and back, and looks very fatigued. As you walk in, he doesn’t acknowledge your presence.
Mum shows you his latest temperature, 40.3°C, and explains he has had a high temperature for the past week even after having Calpol. The rash developed last night, and today he has just been very lethargic all day.
Your colleague continues questioning while you start to assess the patient. From your overview, the patient has some cyanosis in his lips and is positioned on his left side with his head tucked into his chest, he is making snoring sounds. He is breathing rapidly, you estimate around 40 respirations per minute. Skin is flushed with the rash visibly on his chest, you feel for a brachial and estimate the pulse to be 160 beats per minute. On assessing disability, the patient seems semi alert but is very lethargic, only responding to your verbal ques.
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Given the information, what is your first concern within the primary survey assessment
As the patient is on their side, you manage the airway with manual manoeuvres and help clear some secretions. The patient is no longer snoring. You put a finger SPO2 probe on and readings return as 91% saturations on air, with heart rate of 165. What is the child’s current POPS score with the following observations and concerns: HR 165, Resp rate 45, SPO2 91%, Temp 40.3°C, V on AVPU, Airway sounds now clear, High level of concern, No PMH
You are managing the airway, what actions are required for the low SPO2
You place O2 on the patient and signal to your colleague you need to urgently transport this child to hospital. Within a poorly child setting what is advised, should you look rapidly transport to hospital in a ‘scoop and run’ or should you stay on scene to manage and try to treat
With mum’s help, you move the patient into the ambulance and lay him on the stretcher. You confirm with control that a Paramedic on an RRV will meet you half way to the hospital to jump on board to assist. In the back of the ambulance you conduct another primary survey. With patient positioning and O2, their airway is secure and SPO2 levels are around 98%. Breathing is still rapid at around 45 resps per minute, but on auscultation the chest sounds are clear. You assess circulation and still have a heart rate of 170 BPM. You conduct a blood pressure and it comes back at 69/41. Is this blood pressure within normal parameters for a child this age
You lift and position the child’s legs to try and assist with the Blood pressure. You have started your way to hospital on blue lights and the child is still lethargic and only V on AVPU. As you assess the patient, you have noted several unusual signs and symptoms which mum confirms to you she has noted develop over the past 2 days. Along with the rash, the child’s eyes are also red and swollen, their feet and hands seem to be swollen and red, their lips and tongue are very red and sore, and while you have done manual airway control, you feel that lymph nodes at the sides of the neck are swollen. Given all these signs and symptoms present, what clinical impression do you have that may be the cause
You look up Kawasaki’s Disease and confirm that all of the signs and symptoms match the condition. Can Benzylpenicillin be given to treat the disease
You continue to manage airway and breathing while your colleague has given a pre-alert to the receiving hospital. You pull over briefly where the Paramedic comes on board. You quickly handover the history and your impression of Kawasaki’s Disease, and they continue to assist in the patient’s management. Given the information on Kawasaki’s Disease, what stage of the disease is this
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