This case is written by Dr. Kyla Caners. She is a staff emergency physician in Hamilton, Ontario and the Simulation Director of McMaster University’s FRCP-EM program. She is also one of the Editors-in-Chief here at EmSimCases.
Why it Matters
Children with true septic shock are, thankfully, a rare presentation in the ED. However, recognition of early shock is an essential skill. This case highlights several important features of managing the critically ill child, including:
- The need for early vascular access (whether that be intravenous or intraosseous, it must be obtained expediently)
- The importance of monitoring for and treating resultant hypoglycemia
- The need for early antibiotics
Clinical Vignette
A 4-year-old girl presents to your pediatric ED. Her mother states she is “not herself” and seems “lethargic.” She’s had a fever and a cough for the last three days. Today she just seems different. She was brought straight into a resus room and the charge nurse came to find you to tell you the child looks unwell.
Case Summary
A 4 year-old girl is brought to the ED because she is “not herself.” She has had 3 days of fever and cough and is previously healthy. She looks toxic on arrival with delayed capillary refill, a glazed stare, tachypnea and tachycardia. The team will be unable to obtain IV access and will need to insert an IO. Once they have access, they will need to resuscitate by pushing fluids. If they do not, the patient’s BP will drop. If a cap sugar is not checked, the patient will seize. The patient will remain listless after fluid resuscitation and will require intubation.
Download the case here: Pediatric Septic Shock
ECG for the case found here:
(ECG source: http://lifeinthefastlane.com/ecg-library/sinus-tachycardia/)
CXR for the case found here:
(CXR source: http://radiopaedia.org/articles/round-pneumonia-1)
EM Sim Cases 