Your ambulance has been dispatched to a residence for a reported “sick infant.” The caller stated that her two-month old son is not acting right. As you approach the home you note that it is in a very run down state. You see nothing that makes you feel as though the scene would be unsafe.
You and your partner put on your Personal Protective Equipment and gather your pediatric responder bags and equipment. You approach the home and knock on the door. You are directed inside to the living area of the home. You enter cautiously to ensure scene safety.
Once inside, the infants mother, who is holding the child, greets you. She tells you that the child has been sick for two days with fever and a runny nose. He has been taking less and less of his bottle and this afternoon has not been his normal self. You assess the infant.
Your first impression is that the infant appears to have a decreased level of responsiveness, his color is slightly pale and he is breathing fast. You ask the mother to place the child on the couch so you can continue to assess him. You direct your partner to begin Oxygen at 10 LPM with an Infant O2 mask. You reassess the airway, which is open and patent. Moderate amounts of nasal congestion is noted but is easily relieved by your partners use of a bulb syringe. He is breathing at 36/minute but non-labored. Clear, bilateral breath sounds are auscultated. Pulse Oximeter reads 99% on Oxygen therapy. Assessment of circulation reveals that he has a rapid brachial pulse rate of 168 and his capillary refill is 4 to 5 seconds. His overall skin temperature is warm. You note that his mucous membranes are dry. You connect an ECG monitor and detect Sinus Tachycardia in the 160s. When asked, the mother states that the child has not wet a diaper this day. You prepare an IV placement by spiking a bag of Normal Saline utilizing a Buretrol device. Your first attempt at placing an IV in the posterior hand is unsuccessful. The infant barely flinches to your attempt. You then successfully insert a 22-gauge catheter into his right saphenous vein utilizing an aseptic technique. You secure the device in place and connect your IV tubing. You are able to see good flow with no signs of infiltration. You perform a blood glucose on the flashback chamber of the IV catheter. Blood glucose is 88mg%/dL. Utilizing your Broselow Tape you determine that the childs weight is 4 Kg. Per your protocol for this child you decide to administer IV Normal Saline boluses at 20mL/Kg. You begin your first bolus of 80mL, as you transfer him to the ambulance stretcher with the pediatric transport seat attached. You move the child to the ambulance with his mother accompanying you.
Once in the ambulance, you begin transport to County General, which is 15 minutes away. You continue to reassess the infant thru the completion of your first bolus. You assess his Vital Signs, which are as follows: B/P 72/42, HR 168, and RR 36. You assess the head and detect that the anterior fontanel is slightly depressed. The abdomen is soft. Assessment of the extremities reveals a delay of capillary refill and minimal response to painful stimulus. After the first bolus completes, you find that his color has improved and that he is somewhat more responsive. However, his heart rate remains in the 150s and his capillary refill time continues to be 4-seconds.
You decide to initiate a second bolus of Normal Saline also at 80mL. During the transport you complete the second IV bolus. Your reassessment reveals that the infant is much more alert and interacting with his mother. His capillary refill time is less than 3-seconds and his heart rate is in the 120s. His skin color is pink and he is warm. You arrive at the pediatric Emergency Department where you give your report to the staff. They compliment you on a job well done.