Transfer of care: malaise, emesis, reduced po intake part 2


• Scene – IV attempts, vitals, 12 lead, Hxa
• We don’t have any oral fluids, otherwise we would have tried them. We attempted IV without success. The immediate care team made four attempts.
• En route – IV attempt, vitals, TT, EKG,
• Hospital – oral fluids will be attempted


• Patient remained the same throughout the call. No tears when she cried.


Mark Shelton Paramedic Woodburn Ambulance


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


• Vomiting
• Hypovolemic dehydration
• with petechial rash secondary to cough and vomiting.

Differential Diagnosis

• Dehydration
• Gastroenteritis
• Food poisoning

Patient Workup History

• Caregiver states – Mom says pt got sick yesterday and vomited numerous times. Patient only had about 10 ounces of fluid and couldn’t keep any solids down. No one else in the family is sick. Only one wet diaper today.

Physical Exam

• Physical findings – dehydration, hypotension, lethargy, although pt is alert and tracks with eyes
• GCS – 15
• EKG – sinus tach
• CBG – 63

Editor’s Notes

Transfer of care from provider to provider is a critical element of good care. Paramedics, nurses, clinicians all need to work together to deliver optimal care. Making good eye contact with “closed loop communication,” especially when preparing and administering medications, is key. In this case, the history is concerning for dehydration. The fact the child is crying (unable to see if tears are present) is actually a good sign. Ondansetron (Zofran) can be an effective anti-emetic in children with poor po intake with emesis.

-Dr. David Spiro

Standard Approach Notes

• Capillary refill is only one of many exam findings for children at risk for dehydration.
• Checking vital signs is also a key measure of hydration status.
• Making tears and moist lips are two findings that are reassuring in assessing children for hydration status.
• Gastroenteritis is a significant cause of morbidity worldwide.

Suggested References

Emergent Treatment of Gastroenteritis
How to use capillary refill time


• Gender: Female
• Age: 2 years
• Height: Not Available


• Temperature: 97 F/36.1 C
• Blood Pressure: 96/58
• Heart Rate: 140
• Respiratory Rate: 22
• Pulse Oximetry: 100% RA

Signs and Symptoms

Dehydration, lethargy, poor po intake

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