Medical Intermediate
Urticaria with severe reaction
Pediatric · 11yr · male
Patient Information
- Dispatch
- Liam has come to the First Aid stand during an Australia Day event.
- Patient
- Liam James — 11yr (55kg)
- Incident History
- After being stung by a bee.
- Emergency Contact
- Julie James (Mother) — 0454040041
Initial Rapid Assessment
- Response
- Alert
- Airway
- Patent. Nil airway obstructions. Nil airway swelling or stridor.
- Breathing
- Shortness of breath.
- Circulation
- Rapid and weak pulse. Skin left arm — red welts that are itchy.
- Disability
- Orientated to Time, Place and Person.
- Exposure
- Bee sting still on his left forearm. Red welts on left forearm that are itchy.
Vitals
| Time | SpO2 | Resp Dist | RR | Pulse | BP | CRT | GCS | PERL | Temp | BGL | Pain |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Initial | 94% (RA) | Mild | 20 | 100 | 70 | <2s | 15 | 3 3 ++ | 37.2 | 5.3 | 3 |
| 10 mins | 98% (RA) | Nil | 16 | 84 | 98 | <2s | 15 | 3 3 ++ | 36.9 | – | 2 |
History Taking
- Signs/Symptoms
- Mild respiratory distress. Dizzy and pale. Red welts on the skin that are itchy.
- Allergies
- Nil
- Medications
- Multivitamin
- Pertinent History
- Nil
- Last Oral Intake
- Lunch — hot dog and chips with a coke, 2 hours ago.
- Events Leading
- Having fun at Australia Day.
- Treatment Prior
- Nil
- Onset
- Fast
- Pain
- Sudden
- Quality
- Itchy
- Radiates
- Nil
- Severity
- As per vitals
Treatment Response
Diagnosis
This patient is suffering from urticaria with severe reaction.
Facilitator Triggers — if trainees miss a critical step
- ! If second body system not found — start to vomit.
Treatment Objectives
- 1 Officers must gain consent as not life threatening at this stage.
- 2 Officers should perform a rapid primary survey and recognise potential life threatening circulation after blood pressure — then EpiPen (patient admitted he is 55kg).
- 3 A full vital sign survey should be conducted following initial assessment.
- 4 Salbutamol MDI 12 sprays due to shortness of breath with a wheeze.
- 5 Scenario ends on arrival of ambulance and IMISTAMBO handover.
- 6 Attention to hand hygiene throughout the scenario.
Clinical references: CPG — Anaphylaxis · CPG — Urticaria
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