Acute onset fever, emesis and tachypnea


• Scene – IV, vitals, Hx

• En Route – O2, vitals

• Hospital – Transported to pediatric ED


• Unknown


Elliot Williams, Paramedic Woodburn Ambulance


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


• Respiratory distress
• Pneumonia

Differential Diagnosis

• Pneumonia

• Asthma exacerbation

• Bronchiolitis

• Viral pneumonitis

• Empyema

• Dehydration (secondary to pneumonia)

Patient Workup History

• Caregiver states – pt has been sick for 3 days.

• Has less-frequent wet diapers over same period. Less oral intake – food and fluids.

• Vomiting over past couple of days.

Physical Exam

• X-ray shows pneumonia

• GCS – 15, then 12 enroute due to sleeping

• CBG – 90

Editor’s Notes

The medical staff seemed concerned about this child’s level of hydration and work of breathing. When a colleague is concerned about a child, it is critical to be direct and clear about their concerns and verify these findings for yourself. Clearly this child is BOTH tachycardic and tachypneic, which may be in part due to the child’s stated fever of > 102F.

-Dr. David Spiro


• Gender: Male

• Age: 19 months

• Height: Not Available

• Weight: Not Available


• Temperature: 102.3 F/39.1 C

• Blood Pressure: Not Available

• Heart Rate: 150

• Respiratory Rate: 32

• Pulse Oximetry: 96-99% RA

Signs and Symptoms

Difficulty breathing; fever; vomiting; >oral intake; >wet diapers

History Medical

• PMH: Possible asthma

• Allergies: None

• Dispatch info: Difficulty breathing


• Lives with parents and five siblings. No other sickness in family reported by mom.


• Meds-NACL (IV fluids) about 150ml and O2 via blow by

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