Acute fever and emesis


• Scene – vitals, IV start a 100cc fluid bolus, TT
• En route –TT, assess vitals
• Hospital – rectal temp of 104F


• Response to treatment – he seemed to perk up some en route after some fluids. He interacted with me, smiling and grabbing at things during transport.
• Transport to hospital emergency department.


Mark Shelton Paramedic Woodburn Ambulance


David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Fever
• Vomiting

Differential Diagnosis

• Viral syndrome
• Acute otitis media
• Pharyngitis
• Pneumonia
• Intussusception
• Gastroenteritis
• Dehydration
• Febrile seizure

Patient Workup History

• Upon arrival pt did not have any apparent reaction that medics were there.
• Patient history of dark urine may suggest dehydration. He went to the hospital yesterday and was given a neb treatment; sent home with nebs.
• Patient had some congestion yesterday and Mom thinks that is better today.
• Tonight Mom gave patient a lukewarm bath with rubbing alcohol in it to cool him off.
• When they were taking him out of the tub the father put his forearm on the patient’s abdomen and thought it looked like the patient was in pain.
• Caregiver states – patient has not been eating well today. Has a productive cough with frothy white, yellow, greenish sputum. Mom gave him Tylenol about 2 hours ago. Not sure of the dosage.

Physical Exam

• Physical findings – lethargy, fever, dehydration, possible pneumonia
• CBG – 87
• GCS – 15
• EKG – n/a

Editor’s Notes

It’s hard to discern in this case if the child had altered mental status. Fever often makes children less attentive to their surroundings. The paramedics asked extensive questions about the child’s baseline health and status. It’s also key to understand if there are any baseline medical problems to consider when obtaining the history.

-Dr. David Spiro


• Gender: Male
• Age: 14 months
• Height: Not Available
• Weight: Not Available


• Temperature: 102.1 F/38.9 C
• Blood Pressure: Not Available
• Heart Rate: 122
• Respiratory Rate: Not Available
• Pulse Oximetry: 97% RA

Signs and Symptoms

Recent nasal congestion; fever; possible abdominal pain.

History Medical

• PMH: None
• Allergies: None
• Dispatch info: Fever of 104 F, has vomited today.


• Lives with mom and dad; they both did not feel well today but did not have fevers.


• Tylenol and albuterol prn

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