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Station Lead

Dr. Bonnie SinghAngela Benton and Dr. Kevin Connolly

Objectives for Station 1 - Neonatal Sepsis

  1. Identify abnormal vital signs in a neonate.
  2. Initiate appropriate monitoring.
  3. Recognize the need for IO access when attempts at peripheral IV fail.
    1. Procedural practice at placing IOs.
  4. List the appropriate antibiotics for an infant <1 <2 month old.
  5. Identify the signs of shock in an infant.
  6. Order the appropriate fluid bolus.
  7. Reassess the patient after an intervention.
  8. Procedural practice at performing lumbar punctures. 

Objectives for Station 2 - Pediatric Asthma

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Pediatric Boot Camp Scenarios

 


Case 1: Sim Baby with Sepsis

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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. 

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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

 

ROS:

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.

 

Exam:

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

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skin: cool extremities, dry, intact, no rashes or ecchymosis

patient vocal sounds: not vocalizing

 

Proposed treatment:

Wash hands

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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:

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If no IO, or antibiotics:

Worsening hypotensiontachycardia, tachycardia tachypnea, and tachypneahypotension

Minimally unresponsive à or unresponsive

Discussion points:

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Antibiotic agents and coverage in < 3 <2 months old

 

 

Case 2: Sim Junior with Asthma

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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

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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”.

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Recognizes respiratory distress

Calls for help

Orders albuterolAlbuterol

Considers CXR

Considers NS bolus

Considers ipratropium Ipratropium and solumedrolSolumedrol

Reassess respiratory status

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