Case Study (2) for Paediatrics for Critical Care Paramedics

Question :
You are working as a critical care or intensive care paramedic in an ambulance. You are called to the following patient. The question has 2 parts:
1. In less than 100 words, explain why the blood pressure appears normal despite the mechanics of injury. (WORTH 4 MARKS).
2. Outline in point form, your management, including all medications, interventions, calculations used to manage this patient, up to the point of transfer. You are not restricted to your local protocols. (WORTH 16 MARKS).
You are called to an 8 year old male child who has been involved in a pushbike versus pole crash. The child was wearing a helmet which does not appear damaged. Witnesses state the child was riding down hill at speed, hit the pole with the front wheel and was catapulted over the handlebars. There was no LOC. No significant past medical history, current medications, allergies.
On arrival – the child is lying in his left side, alert, distressed, complaining of significant bilateral upper abdominal pain. Denies other pain.
On examination – Airway patent. Breathing – rapid and shallow. No obvious wheezes, rales, crackles. Equal bilateral air entry. Circulation – pulse rapid and slightly weak to palpate. BP normal for age. Skin cool and slightly clammy. Disability – GCS normal for age. Nil gross neurological deficits. Exposure – pain and guarding to upper abdominal quadrants. No other obvious injuries, signs or symptoms.

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