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Hamilton CME

An 8-year-old patient presents with severe dyspnea (shortness of breath) after playing with cousins at a family farm. The onset was sudden and of unknown origin, characterized by head-bobbing, lethargy, and confusion. Primary assessments revealed tachypnea, increased work of breathing, and minimal air entry. The child's medical history includes asthma, with no relief from MDI medications. This case highlights the importance of focused assessment and differential diagnosis in pediatric emergencies.

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Hamilton CME

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Presentation Transcript

  1. Hamilton CME Pediatric Case Presentation Spring 2008

  2. Case Intro • 8 y.o. SOB • Visiting family farm • Playing with cousins • Unknown mechanism

  3. Case Intro • Severe dyspnea • Head-bobbing • Tired / lethargic

  4. Differential Diagnoses?

  5. Primary Assessment • “can’t breathe” • Tachypneic •    WOB • Very little AE

  6. Primary Assessment • Weak, thready carotid pulse • Pale ++, dry skin ++ • Eyes open to voice • Confused • Obeys commands

  7. Focused History • Playing “hide & seek” • Found SOB ++ • MDI medications = no relief • Asthmatic history

  8. Focused Examination

  9. Focused Examination •   AE • Accessory muscle use • Retractions • Paradoxical breathing

  10. Working Diagnosis?

  11. PCP Airway Breathing Circulation Drugs Extra Care ACP Airway Breathing Circulation Drugs Extra Care Treatment Options

  12. Enroute

  13. Enroute

  14. Teaching Point

  15. Teaching Point

  16. References • Emergency Medicine: A Comprehensive Study Guide - 6th Ed • PEDIATRIC ASTHMA AND BRONCHIOLITIS - Maybelle Kou, Thom Mayer

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