Workbook Exercises : Case 1 An 18-month-old girl presents to ED after several vomits at home this morning. She seemed a bit off her food last night and woke up in the early hours of the morning when she started to vomit. Since then she hasn’t been able to keep anything down. She has had no fevers but has had one episode of diarrhoea prior to presentation. 1. How would you assess her fluid status? What would you look for on history, examination and observations? 2. Other than looking a little coryzal and mildly dehydrated she examines well, how are you going to treat her? 3 After 2 hours she has tolerated 300mls of gastrolyte and had no further vomits. She appears well with normal observations and you think she may be able to go home. What advice should you give her parents on when to return? Where can you find patient handout information?
Case 2 An 18-month-old boy presents to ED with 24 hours of vomiting. He appears quite lethargic and is carrying a bucket. He has no fevers. He is placed in a cubicle and started on a trial of oral fluids. After eating a gastrolyte ice block he vomits again and then falls asleep. 1. Would you consider prescribing an anti-emetic, which one would you choose and what dose and route? 2. How are you going to deliver fluids to this child and at what rate? 3. Describe how you would insert an NG into this child?
Prescribing Fluids On the chart in your workbook, please prescribe the following : 1. Maintenance Fluids for a 12 year old boy who weighs 43kg 2. Fluid bolus for a septic neonate who weighs 3.6kg 3. Rapid Rehydration for a 6 year old girl with gastroenteritis who weighs 20kg 4. Slow rehydration over 24 hours for a 5 year old boy who weighs 16kg and is 5% dehydrated 5. Maintenance fluid for a 8 day old baby who weighs 3.2kg