Tachypnea, tachycardia and fever


• Scene – just Hx from staff
• En route – VS
• Hospital – dexamethasone at 0.6mg/kg


• Response to treatment – he responded well to the meds given by peds clinic, but after about an hour his cough came back and had a little stridor.
• Transported to Peds ED


Mark Shelton Paramedic Woodburn Ambulance


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


• Respiratory illness

Differential Diagnosis

• Croup
• Bronchiolitis
• Pneumonia
• Reactive airway disease

Patient Workup History

• Patient states – NA but is able to track with eyes and knows who mom is.
• Caregiver states – pt has been sick since last night. He was given meds for fever last night, it seemed to help for a while.

Physical Exam

• Sat – 94% RA before meds; 98% RA after albuterol and racemic EPI
• GCS – 15

Editor’s Notes

Dealing with a language barrier can be a major barrier for any clinicians. It’s very important for EMS crew and emergency clinicians to get a good understanding of past medical history and current medications as they receive a pediatric patient, and often this can be challenging with patients and their families who can’t speak English. This child was febrile, tachycardic and tachypneic with low sats, but looked attentive especially towards the end of the video clip. It is unusual to receive both albuterol and racemic epinephrine nebulizers.

Suggested References

Lost in translation


• Gender: Male
• Age: 26 months
• Height: Not Available
• Weight: Not Available


• Temperature: 103 F/39.4 C
• Blood Pressure: Not Available
• Heart Rate: 152
• Respiratory Rate: 30
• Pulse Oximetry: 94% RA

Signs and Symptoms

Stridor, intercostal retractions, abdominal breathing, wheezing

History Medical

• PMH: Pt was born premature, we heard anywhere from 25 weeks to 34 weeks, and there was a language barrier, so we are not exactly sure. He is prone to illness.
• Allergies: None
• Dispatch info: Difficulty breathing, cough, fever.


• Lives with mom and dad, 3 siblings


• Tylenol, ibuprofen

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