Pediatrics
Acute pediatrics
The deteriorating child, frame by frame: age-adjusted vitals, effort, perfusion, mental status and urine, with the previous frame kept on screen so the change is the thing you see. Then: which child do you see first?
The deteriorating child
2 years · 12 kg · Pediatric ward, room 3
The quiet toddler with a fever
A 2-year-old admitted overnight with fever and vomiting. The heart rate has not settled with the fever, and she has stopped fighting the nurses.
3 frames
4 months · 6.2 kg · Pediatric ward, room 5
The infant on 2 litres
A 4-month-old with bronchiolitis, day 3, admitted this afternoon on low-flow oxygen. The night shift has started.
3 frames
9 years · 28 kg · Pediatric high-dependency bed
Ketoacidosis, hour six
A 9-year-old with new diabetes in ketoacidosis, six hours into fluids and an insulin infusion. The glucose is falling beautifully.
3 frames
Which child first?
Four children, one of you
1
8-year-old with fever, comfortable
39.1, playing on a tablet, drinking. Heart rate 110.
2
12-year-old waiting for a discharge prescription
Post-appendicectomy day 2, eating, wants to go home.
3
4-month-old with increased work of breathing
Respiratory rate 64, subcostal retractions, saturation 92 percent, took a third of the last bottle.
4
6-year-old with mild abdominal pain
Pain for 6 hours, periumbilical, vomited once, hopping happily in the corridor. Heart rate 96.
Which child first?
The evening ward round, interrupted
1
3-week-old with jaundice, phototherapy
Bilirubin falling, feeding, wet diapers, mother asking when she can go home.
2
2-year-old with croup, post-epinephrine
Epinephrine given 40 minutes ago for stridor at rest. Now settled and asleep. Nurse asks if he can go to the ward.
3
15-year-old with new diabetes, off the infusion
Transitioned to subcutaneous insulin at lunch, ate dinner, glucose 9. The nurse says he seems 'low' in mood and asked to be left alone.
4
7-year-old with asthma, hourly salbutamol
Heart rate 148, respiratory rate 32, saturation 93 percent on 2 L, saying she feels 'weird'. Air entry reduced on the left.