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   BP: 95/60 (MAP 72)
• 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?

Normal range for vital signs by age

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

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