PALS Megacode 6 Out-of-Hospital

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You are a healthcare provider working on an ALS ambulance. You are dispatched to the home of an 11-year-old boy who according to dispatch is febrile, lethargic, and diaphoretic. Your response time to the scene is 4 minutes. Upon arrival, the father rushes you into the home where you find the mother tending to the child in their bedroom. A rapid initial impression (ABCs) reveals the following:

  • Appearance: Toxic, weak, lethargic
  • Breathing: Increased respiratory effort, rapid, labored
  • Circulation: Flushing
1. An initial impression tells you that the child is responsive, but in respiratory distress. As your ALS partner begins opening the jump bag, you notice that the child’s left forearm is wrapped in first-aid gauze. Upon inquiry, the father explains that the child fell yesterday evening while playing at the park and that a piece of glass punctured his arm. The father further reports that the child appeared fine after the event, but started complaining of localized pain a few hours ago, followed by a high fever and general malaise. What differential should you be considering in the given scenario?*