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A. Molina García, C. García Mauriño
Residentes hospital infantil universitario La Paz
4. Role play: Rounding the floor. Resident presenting patient with anaphylaxis to the attending physician
Resident: Wyatt is a three-year-old boy who was admitted to the floor yesterday. He presented to the emergency room (ER) with puffy eyes and increased work of breathing. His mother said he is not allergic to anything that she knows of. Apparently, they were having lunch when she noticed the swelling of the eyes and she brought him directly to the hospital. At the ER they noticed Wyatt had increased work of breathing, and was tachypneic and starting to present some hives. He was monitored and was found to be tachycardic, although he maintained blood pressure within normal ranges, as well as his oxygen saturation. They placed an iv peripheral line and administered a 20 ml/kg bolus of normal saline. He then received a 2 mg/kg dose of iv steroids and a single dose of im adrenaline. The symptoms subsided slowly and he was asymptomatic after a couple of hours. He was then admitted to the floor.
Since admission, he has been stable, with constants within normal limits. He has been asymptomatic and the physical examination today was unremarkable. Labwise, today we asked for CBC´s and LFT, both of which were within normal values.
Wyatt has all his vaccines up to date. He has no known allergies, although his mother remembers that one time when taking amoxicillin for an episode of acute otitis media, he presented some hives. He has taken Amoxicillin after that and he has had no symptoms since then. When he was two, he was admitted for fever and was finally diagnosed of pneumonia. He was treated with antibiotics and the process was resolved without any complications. No other hospital admissions. No surgeries.
Regarding family history, both parents are healthy. He has one sibling who is two years older than him and is also healthy, never been admitted. They live altogether and they have a dog.
Attending: Ok, very good. What about the treatment, what is he currently on?
Resident: He is on steroids, 1 mg/kg Q12.
Attending: And what about the line? Is he still on IV fluids? What about his oral intake?
Resident: apparently, he is refusing to eat, but I spoke to his mother this morning and encouraged her to insist and it seems the kid is doing better.
Attending: And what do you think triggered these symptoms?
Resident: well I asked if Wyatt had anything new during lunch, but apparently, he was eating pasta, and he had eaten pasta many times before, so I’m not really sure.
Attending: What about your assessment and plan?
Resident: Well, Wyatt is a three year old who had an anaphylactic reaction, although we are not sure to what. My plan is to discharge him once his oral intake is adequate and the line can be removed. I think we should send him home on oral steroids and give him an appointment for the allergy outpatient consult, where they can look into what caused the allergic reaction and run the necessary tests.
Attending: Very well, I agree. Touch base with the allergy service to make the appointment. I would also like to follow her up, so please give him an appointment with us in a couple of days.
KEY WORDS:
Rounding the floor: pasar planta de hospitalización.
Attending physician: médico adjunto.
Admitted to the floor: ingresado en la planta.
Emergency room: sala de urgencias.
Puffy eyes: ojos hinchados.
Increased work of breathing: aumento del trabajo respiratorio.
Hives: urticaria.
IV peripheral line: vía venosa periférica.
bolus of normal saline: expansión con suero salino fisiológico.
Subsided (to subside): disminuir.
Unremarkable: sin hallazgos significativos.
Labwise: en relación con los resultados de laboratorio.
CBC´s (complete cell blood count): hemograma.
LFT (liver function tests): estudio bioquímico de función hepática.
Acute otitis media: otitis media aguda.
Hospital admissions: ingresos hospitalarios.
Family history: antecedentes familiares.
Q12: cada 12 horas.
IV fluids: fluidoterapia intravenosa.
Oral intake: ingesta oral.
Triggered (to trigger): desencadenar.
Discharge: dar de alta.
Outpatient consult: consultas externas.
Touch base: ponerse en contacto.
