Paramedicine Paediatric Care in the Prehospital Settings - Assignment Example

Paramedicine Paediatric Case Studies Name Course Lecturer School Town Date Case Scenario Number 1. Question 1 Response. The Pathophysiology of symptoms presented The patient described in case scenario number one presented with sudden onset of some abnormal signs and symptoms. They included shortness of breath that was accompanied by tachypnea of 38 breaths per minute and increased effort in breathing. In normal situations, six-year-old children have a respiratory rate of 18-30 breaths per minute with effortless unconscious breathing. The child had also developed an expiratory wheeze, which indicated an exacerbation of Asthma. A heart rate of 132 was above the normal range of 75-115. The patient presented with acute urticaria as shown in the photograph. Abnormal breathing rate and heart rate can be caused by a combination of several agents such as histamine, prostaglandin D2, and leukotrienes. Histamine release is one the factors that promote vasodilation and increased heart rate. Prostaglandin D2 causes bronchoconstriction and it is both coronary and pulmonary vasoconstrictor as well as peripheral vasodilation. Leukotrienes are Broncho constrictors and peripheral vasodilators. Urticaria is triggered by the release of several agents such as histamine, leukotriene C4, prostaglandin D2, bradykinin (Brown, 2006). Foods (mostly peanuts and other tree nuts), drugs such as antibiotics, vaccines as well as insect venoms can trigger the release of the anaphylactic agents. In the scenario presented, it is possible the allergen that triggered the pathophysiology of the symptoms describes above was contained in the chocolate that the child was eating. The symptoms developed as a result of activation of mast cells due to cross-linking of Immunoglobulin E and aggregation of receptors for IgE. When mast cells are activated, they are responsible for the release of histamine among other agents such as prostaglandins, leukotrienes, and platelet-activating factors. Other mediators responsible for anaphylaxis reaction such as cytokines and chemokines are released (Brown, 2007). Histamine, prostaglandin D2, and leukotrienes cause vasodilation thereby lowering the blood pressure. The heart rate is increased to correct the blood pressure levels and hence deliver oxygen sufficiently to the vital organs. Another effects of histamine, prostaglandin D2 and leukotriene is bronchoconstriction, which results in insufficient gaseous exchange. In an effort to increase oxygen supply, the respiratory rate rises, unfortunately, leading to shortness of breathing. Abdominal muscles are used to counter the effect of bronchoconstriction to increase oxygen supply as per demand. The case scenario presented is a patient with a history of Asthma. Bronchoconstriction worsens and masks the effect of Asthma resulting into expiratory muscles and use of abdominal muscles to push air out of lungs (labored breathing) (Brown, 2007). The dermal mast cells and basophils are activated by allergens to produce histamine, leukotriene C4 prostaglandin D2 and other vasoactive agents that are responsible for urticaria, which is characterized by red skin and elevated papules as shown in the photograph attached. Urticaria results from extravasation of plasma into dermis as a result of those vasoactive agents. The itchiness of the urticaria is caused by histamine release (Brown, 2007). Question 2 Response: The preliminary diagnosis The preliminary diagnosis is an anaphylactic shock. This is because the history of patient and scenario is indicative of sudden onset. Moreover, the accompanying symptoms of sudden respiratory and cardiovascular compromise in addition to urticaria are classic symptoms of anaphylactic shock. The patient history of asthma and several other food products is indicative of a person who is sensitive to many things and with a potential to develop an acute anaphylactic reaction to allergens. Question 3 response: Management of the patient. Being a medical emergency, the anaphylactic reaction requires immediate life-saving interventions. Monitoring of vital signs (temperature, blood pressure, pulse rate, respiratory rate) is important considering that they will determine the type of care accorded to the patient. Mental status examination, as well as skin assessment, also provide vital information that guides treatment. Due to respiratory compromise, the patient is put on a high flow oxygen therapy (Schummer, Schummer, Wippermann, & Fuchs, 2005). Intravenous access (IV) is important for the administration of fluids and medications as required from time to time. The IV line should be large caliber to accommodate administration of large volume of fluid administration, which is approximately 20mg/kg. Isotonic crystalloid fluids such as Isotonic saline and Ringer’s Lactate are administered to restore blood volume hence help relieve the symptoms of blood pressure compensatory mechanisms. Additionally, the patient is nurses in a supine position to improve comfort and gaseous exchange with legs elevated to improve venous return (Schummer et al., 2005). Epinephrine is administered intramuscularly to antagonize the effects of released mediators thereby restoring normal blood pressure and breathing rate. It can be administered via a nebulizer to relieve the Bronchoconstriction. The patient should be transferred to the nearest facility for further examination and management (Schummer et al., 2005). Case Scenario 2 Question 1. Pathophysiology causing those symptoms The case scenario 2 presents a very sick child as indicated by the semi-conscious patient. In addition to having a history of common cold diagnosis that was not treated, the patient manifests with unresponsiveness to verbal commands, being sleepy, irritable and unusually lethargic which indicates neurological system compromise. The patient has pale skin, reduced capillary refill (normal is Read More