Dehydration — Paediatric at community fun run

Patient Information

Dispatch: You are called to a patient (Liam Chen, 8-year-old male) who has come to the First Aid Post during the Fremantle Schools Fun Run. His mother reports he is dizzy, has a headache, and has vomited once.
Patient: Liam Chen — 8yr (26kg)
Incident History: Pt completed a 5km fun run in warm conditions without drinking adequate fluids. Has vomited once and is now dizzy and complaining of a headache. Mother present.
Emergency Contact: Michelle Chen (Mother) — 0412 387 045

Initial Rapid Assessment

Response: Alert
Airway: Patent. Nil airway obstruction. Nil stridor.
Breathing: Slightly increased respiratory rate. No accessory muscle use. No audible wheeze or crackles.
Circulation: Radial pulse rapid and weak. Skin pale, warm and dry. Lips dry and cracked. Capillary refill 3 seconds centrally.
Disability: GCS 15 (E4V5M6). Alert and orientated to time, place and person. Complaining of headache and dizziness.
Exposure: No rashes or injuries. Skin appears dry. No sweating noted.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	97% (RA)	Mild	24	118	88/60	3s (central)	15	3 3 ++	37.9	4.2 mmol/L	4
10 mins	98% (RA)	Nil	20	102	96/64	2s	15	3 3 ++	37.7	4.4 mmol/L	2

History Taking

Treatment Response

Diagnosis

This patient is suffering from dehydration with mild hypovolaemia secondary to inadequate fluid intake during physical exertion in warm conditions.

Facilitator Triggers — if trainees miss a critical step

! (If BGL is not checked within the first 5 minutes, the patient complains of feeling shaky and the mother asks if his blood sugar is okay.)
! (If oral fluids are not offered within 5 minutes of assessment and GCS remains 15, the patient's dizziness worsens and he says he feels like he might be sick again.)
! (If temperature is not assessed, the facilitator prompts: the mother asks 'Could he have heat stroke? He feels hot to me.')
! (If patient is not positioned appropriately — i.e. left standing or sitting upright with dangling legs — the patient nearly faints and requires assisted positioning.)

Treatment Objectives

1 Don appropriate PPE and perform scene safety assessment.
2 Perform Primary Survey — confirm patent airway, assess breathing and circulation, assess GCS and BGL.
3 Obtain full set of vital signs including BP, HR, RR, SpO2, BGL, temperature, pain score, and CRT.
4 Position patient supine or semi-recumbent with legs elevated to improve venous return given tachycardia and low BP.
5 Perform SAMPLE history with mother — confirm nil allergies, nil medications, onset of symptoms, and fluid intake history.
6 Assess for signs and symptoms of heat-related illness (temperature, mental status, skin condition) and differentiate dehydration from heat stroke — temperature 37.9°C does not meet heat stroke threshold; patient is alert and oriented.
7 Offer oral fluids: encourage small sips of water or electrolyte drink as patient is GCS 15 and able to swallow safely. Aim for gradual rehydration.
8 Monitor for nausea — if active vomiting develops or nausea is rated moderate to severe, consider Ondansetron 4 mg sublingual tablet (>4 years, >15 kg, no contraindications). Liam weighs 26 kg and is 8 years old — paediatric sublingual tablet dose applies: 4 mg sublingual tablet, single dose only, not repeated.
9 Reassess vital signs at 10 minutes — expect improvement in HR, BP, CRT, and pain score with correct positioning and oral rehydration.
10 Monitor BGL at reassessment — normal range maintained; no glucose gel required.
11 Reassure patient and mother continuously throughout assessment and management.
12 Document all findings and interventions on ePCR.
13 Arrange transport to hospital if: symptoms do not improve with oral rehydration, patient is unable to tolerate oral fluids, GCS deteriorates, or haemodynamic instability persists. Transport urgent if time critical with IMISTAMBO handover.
14 Scenario ends on arrival of ambulance and IMISTAMBO handover.
15 Attention to hand hygiene will be given throughout the scenario.

Clinical references: Hypoglycaemia · Dyspnoea & Respiratory Distress · Hypovolemic Shock · Heat Stroke · Ondansetron

How did you go?