Question

 The EMS team arrives to take KR to the emergency department before you have a chance to give the ceftriaxone or the antipyretic. After discussion with the physician, KR is taken to the ED while he updates the ED team and informs them that the patient has not received any medications in the clinic.

 Upon arrival to the ED (approximately 1.5 hours after presenting to the clinic), KR is placed in a pediatric treatment bed and hooked up to a cardiac monitor and vital signs are obtained.

 Vital Signs: Weight = 10 kg; HR 180; RR 52; BP 88/44; Temp 39.1°C; Oxygen Sat 98% on Room Air

 The physician immediate orders the following:

•  1. Acetaminophen 150 mg orally x 1 dose

•  2. Ceftriaxone 500 mg IV x 1 dose

•  3. 0.9% Sodium chloride 200 ml IV to infuse over 30 minutes

•  4. Azithromycin 100 mg IV x 1 dose

•  5. Place 2 peripheral IVs

•  6. Blood cultures

 5. In what chronological sequence should the above orders be completed and why?

Answer 1

Chronology

5-3-6-(1+2)-4

First patient's bp is low so iv line started by placing 2 peripheral IVs.

And then, crystalloids started(sodium chloride)

Then blood us taken for blood cultures

Then fever is controlled via acetaminophan and empirical Antibiotic(ceftriaxone) given untill results of blood cultures come

Then azithromycin.

Answer 2

5.First the patient has to be inserted with two peripheral lines as per order.

Then the blood culture can be collected during the peripheral line insertion in order to avoid third prick on the patient. Should be always d8ne prior to administration of antibiotics

Administer 0.9% Sodium chloride 200ml IV after this in order to increase the blood pressure simultaneously fluid administration can reduce the body temperature

Administer azithromycin as it will be a single dise

This has to be followed by ceftriazone

Finally administer oral medication

Answer 3

1. Oral acetaminophen 150 mg to reduce fever.

2. Place two peripheral IVs so as to give iv fluid and medicines

3. 200 ml 0.9% sodium chloride to raise blood pressure

4. blood culture to find out infective organism

5. Azithromycin and ceftriaxone concurrently in two peripheral ivs. to treat underlying infection