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Case Presentation 1: Fever and Not Acting Right

EMS1.com News

February 25, 2008
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From the J&B Archives
by Jones and Bartlett Publishers

Case Presentation 1: Fever and Not Acting Right

Presented by Marianne Gausche-Hill, MD, FACEP, FAAP
APLS — The Pediatric Emergency Medicine Resource 


A mother brings in her 12-month old boy because he has had fever, vomiting, and is not acting right. On examination, he appears listless and does not react to your exam.

Instructor Information
Begin discussion of assessment and management of a patient in shock.

The PAT is as follows

  • Appearance: Abnormal. The boy is listless and lying supine on the gurney – although his eyes are open, he does not turn toward his mother’s voice or you as you approach.
  • Work of Breathing: Normal. The boy’s respirations seem to be at a normal rate and volume. There are no retractions.
  • Circulation to the Skin: Normal. The patient has normal skin color and a fine maculopapular rash on the trunk and legs. You see no petechiae.


Vital signs include

  • Heart rate: 130 bpm
  • Respiratory rate: 28 breaths/min
  • Blood pressure: 80/palp
  • Temperature: 38.9°C
  • Weight: 11 kg


Initial assessment

  • A: Open, no stridor
  • B: Breath sounds clear
  • C: Color normal, skin warm and dry, tachycardia, brachial pulse strong
  • D: Tone normal
  • E: No sign of injury, rash as described


Key Questions

What is your general impression of this patient?

What are your initial management priorities?


Download Case Presentation 1: Fever and Not Acting Right (PDF) - 510 KB

About the author


Educating tens of millions of people worldwide, Jones and Bartlett Publishers is a global leader in educational publishing, providing unique textbooks, reference products, testing and assessment services, and training materials in both print and digital formats. Working with distinguished authors and national organizations, J&B offers authoritative products for students and professionals in schools, corporations, hospitals, government organizations, and the military.

Founded in 1983, J&B is the largest independent publisher focusing on the critical fields of Public Safety, Medicine, Nursing, Allied Health, Health Administration, and Public Health.

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