Patient Assessment - Deep trouble - page 3

The aim of this "game" is to look at critical indicators in assessment. Some of the patients in the following scenario are in "deep trouble" but some may not be. Can you identify the ones in... Read More

  1. by   Peeps Mcarthur
    This is fun!!

    Sure beats algebra anyhoo. I can't wait until I'm training to do the real thing.

    kiddie 4 yrs old 3day Hx malaise and cough, dehyrated, temp 38.8
    I would treat the dehydration with malaise. The other kid is at least stable and with no malaise is not showing neuro deficit. Dehydration on the other hand is a slippery slope. Temps can be wrong but dehydration and neuro deficit need to be treated ASAP.

    In my untrained, anything but humble opinnion.

    I love these!!.......cause I can't affect an outcome on a simulation
  2. by   karenG
    I know this is a tough call but I always worry about kids with temp that dont respond to antipyrexials- there has to be a reason for the high temp and I need to find it! the other child has an obvious problems- and fluids and antipyrexials should do the trip- its probably viral. luckily - we dont see dehydrated children here- more likely to be waterlogged with all our rain!!!!! (or at least I dont see them in primary care!)

    Karen
  3. by   charissa
    Right on, untamedspirit. Kids can look fine on the surface and a short time later can be going straight down the dumper. Their bodies compensate so well that you dont even know they are in trouble, but when they cant anymore it has been so long they take a HUGE nose dive. Heck a kid can be out 20% volume before they even start to show vital sign changes! And if a kid goes full arrest the outlook is never stellar. The whole focus of PALS is catching codes before they happen and preventing them.
  4. by   gwenith
    i'll start numbering the cases so that we can keep them sorted.

    case 6 mr kenevil

    mr kenevil has just walked into your emegecy room he tells you he has been out playing some extreme sports and rode a bicycle down a mountainside. unfortunately he cought a tree limb across his throat and came off of his bike. he is complaining of a really sore neck - can hardly move or twist his neck. but he is less worried about this than his right arm which shows a dinner fork shape to the radius. when he breathes in you notice he has makes slight "snoring" noise. his voice is harsh and he had trouble talking.
  5. by   bklynborn
    protect his airway quick he is swelling
  6. by   KRVRN
    and a C-collar too.
  7. by   angelbear
    I like this good for the critical thinking.
  8. by   Peeps Mcarthur
    Case 6:

    If he fractured his radius and is showing airway compromise, I am concerned with a pulmonary embolus as an emergent problem. If visual inspection reveals trauma below the hyoid then I would suspect more than just whiplash.

    This pt should be intubated before the soft tissue swells to a point when the cords can't be visualized. Then all you have left is a cricoidotomy(I think that's the term).

    Protect the airway
    Draw a gas
    Look for other blunt trauma.
  9. by   karenG
    you are all so impressive- I am learning so much...........pity I work in primary care and dont ever see any of this stuff!!

    Karen
  10. by   Scis
    karenG:
    Never let your guard down, at any time you may be presented with one of these types who waited to see the primary care physician instead of go to the ER. Just when you least expect it.....be prepared! These tips may come in handy!
    Patty
  11. by   karenG
    Originally posted by Scis
    karenG:
    Never let your guard down, at any time you may be presented with one of these types who waited to see the primary care physician instead of go to the ER. Just when you least expect it.....be prepared! These tips may come in handy!
    Patty
    yes thats true!!! dont what gear yoy have in primary care- I have me!! (ok I have a defib, stethacope, otoscope and ophthalmascope, sphig as well) I will admit to being a jack of all trades but I (gulp) have only seen one arrest in 15yrs!

    one I had recently.......what would you all have done?

    lady presented c/o severe abdominal pain, 11 0n 1-10 scale! nothing made it better/worse. pain in left upper quadrant. apyrexial.............and she threw up over me. diagnosis?

    Karen
  12. by   shrek
    These are great practice...thanks.
  13. by   Scis
    karenG:
    OK, to think the worst first---dissecting aortic aneurysm? acute MI? Was this the one arrest?
    Let us know!
    Patty

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