Dr. Bonnie SinghAngela Benton and Dr. Kevin Connolly
Objectives for Station 1 - Neonatal Sepsis
- Identify abnormal vital signs in a neonate.
- Initiate appropriate monitoring.
- Recognize the need for IO access when attempts at peripheral IV fail.
- Procedural practice at placing IOs.
- List the appropriate antibiotics for an infant <1 <2 month old.
- Identify the signs of shock in an infant.
- Order the appropriate fluid bolus.
- Reassess the patient after an intervention.
- Procedural practice at performing lumbar punctures.
Objectives for Station 2 - Pediatric Asthma
Pediatric Boot Camp Scenarios
Case 1: Sim Baby with Sepsis
Ex-term now 5 day old baby boy born at home now with a tactile fever at home and a cough, mom brings the baby to the ER and the baby has not been eating and drinking well for the past 2 days. MGM and 3 y/o sister sick (sister in pre-school). She Mom doesn't have a thermometer so she doesn't know what his temperature has been.
Vital signs: HR 190 (normal range 120-140), 70 (normal range 30-50), 5568/30 41 (SBP 60-100), Temp 38.8 C rectal
Tachypneic but no distress
tachycardic Tachycardic (no murmurs)
lethargicLethargic, difficult to wake up
cap Cap refill 4 seconds
PMH: term Term, NSVD, no prenatal care, 8 lbs (3.6 kg), no known PMH, PSH, meds or allergies. Has not had any vaccinations or blood work done, never seen by a doctor, lives with parents and 3 y/o sister and 5 y/o brother.
started Started 2 days ago with congestion and runny nose, has been taking less milk, exclusively breastfed.
Feeding: takes 1-2 oz every 4-6 h (normal 2-3 oz q2-3 hrs).
Wet Diapers: none since yesterday (normal 5-10/day).
Poops: 1 diarrhea poop yesterday, and none this morning (normal 2-10 soft/day).
SH: lives Lives at home with Parentsparents, MGM, and 5 3 y/o sister sick (sister in pre-school). No smoking or pet exposures. No recent travel.
Vitals taken while baby is lying quietly in mom's arms
HR 190; BP 68/41; RR 4570; Temp 102 F 38.8 C rectal, O2 sat 99% on room air
HEENT: sunken fontanelfontanelle
CNS: listless, moving all extremities when provoked, intact sucking reflex
cardio: tachycardia, poor peripheral perfusion, capillary refill 4 seconds, equal brachial and femoral pulses
respiratory: tachypnea, mild subcostal retractions, clear bilaterally
skin: cool extremities, dry, intact, no rashes or ecchymosis
patient vocal sounds: not vocalizing
Calls for help (Code, not RRT because needs need pharmacy)
Obtain access (will not be able to obtain access with IV), will need IO
- discussion points, where Discussion points: Where to place IO? Tib/fib
- start Start distally and can can work way proximally
- cannot Cannot place another IO in area where previously attempted
Provide bolus (push/pull)
Orders appropriate antibiotics (amp and gent or amp and cefotax, NOT ceftriaxoneAmpicillin/Gentamicin or Ampicillin/Cefotaxime, NOT Ceftriaxone in infants <1mo)
Orders appropriate rule out sepsis work up
- ( CBC with differential, CMP, CRP), Urinalysisurinalysis, urine culture (not just UA with reflex), LP since patient is less than 3 2 months old, CXR
If proper intervention:
If no IO, or antibiotics:
Worsening hypotensiontachycardia, tachycardia tachypnea, and tachypneahypotension
Minimally unresponsive à or unresponsive
Antibiotic agents and coverage in < 3 <2 months old
Case 2: Sim Junior with Asthma
4 yo boy with a past h/o wheezing brought to the ED by ambulance. He has had a cough and runny nose for 2 days and this morning awoke in respiratory distress and struggling to breathe. He is unable to speak in full sentences. Mom is very anxious. EMS has started an IV and started NS at a keep open rate.
Initial clinical signs:
Vital signs: RR 60, HR 140, BP 110/70, 85% on RA, temp 99.9
PMH: Hospitalized last summer in PICU. No intubations. Uses albuterol Albuterol MDI at home on an as needed basis. No controller medication. Last steroid burst 2 months ago. 2 dogs at home and dad smokes (but outside). Triggers are URIs and “cold air”.
Recognizes respiratory distress
Calls for help
Considers NS bolus
Considers ipratropium Ipratropium and solumedrolSolumedrol
Reassess respiratory status