Acute onset emesis, agitation shortly after a meal


• Scene – assessment and vitals

• En route – axillary temp and assess, blow by O2

• Hospital – unknown


• Unknown


Elliot Williams, Paramedic Woodburn Ambulance


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


• Altered mental status
• Potential ingestion

Differential Diagnosis

• Foreign body esophagus

• Poisoning

• Closed head injury

• Non-accidental trauma

Patient Workup History

• Caregiver states – She gave pt a small piece of a bean burrito 15 minutes prior to episode

Physical Exam

• Physical findings – no choking, but pt did appear agitated or uncomfortable and would move into a sniffing position for awhile.

• Lung sounds were clear, moving good air; did not see any objects in airway, no excessive drooling.

Editor’s Notes

During transport, the paramedic asked an astute question of the mother: “How does he look to you now?” The mother responded that the child does not normally cry “like that.” This is important information from the caregiver who understands that patient’s baseline. The child seems to have mild altered mental status with intermittent cry, although the transport itself with strangers involved can be frightening for a 7 month old child.

-Dr. David Spiro


• Gender: Male

• Age: 7 months

• Height: Not Available

• Weight: Not Available


• Temperature: 98.2 F/36.8 C

• Blood Pressure: Not Available

• Heart Rate: 137

• Respiratory Rate: 40

• Pulse Oximetry: 99% RA

Signs and Symptoms

Dry heaves; crying; agitated.

History Medical

• None • Allergies: None

• Dispatch info: Pale, vomiting, conscious, breathing


• Grandma watches pt during the day, and mom picks him up after work. Pt currently has numerous family members with upper respiratory infections.


• None

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