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?

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