Medical

Dehydration — Paediatric (8YO female at community carnival)

Foundation

Pediatric · 8yr · female

Patient Information

Dispatch	An 8YO female has been brought to the FAP by her mother at the Rockingham Community Carnival. Mum says her daughter has been complaining of a headache and tummy ache and hasn't had a drink in hours. (Lily Hargreaves)
Patient	Lily Hargreaves — 8yr (25kg)
Incident History	Pt has been at the carnival since 10am in the sun. Mum reports Lily has not had anything to drink since breakfast and has vomited once approximately 20 minutes ago. She is now complaining of headache, dizziness, and nausea.
Emergency Contact	Sandra Hargreaves (Mother) — 0412 554 783

Initial Rapid Assessment

Response	Alert
Airway	Patent. Nil airway obstruction. Nil stridor.
Breathing	Breathing spontaneously. Slightly increased rate. No accessory muscle use. Nil adventitious sounds.
Circulation	Radial pulse present — slightly elevated, regular. Skin warm, dry, and pale. Capillary refill 2–3 seconds. Nil external bleeding.
Disability	GCS 15 (E4V5M6). Alert and orientated to time, place and person. Mild irritability. Complaining of headache.
Exposure	Nil rashes, nil injuries. Pt has been in direct sunlight for several hours. Lips appear dry and slightly cracked.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	97% (RA)	Nil	22	108	90/60	2-3s	15	3 3 ++	37.8	4.8 mmol/L	4
10 mins	98% (RA)	Nil	18	96	96/64	<2s	15	3 3 ++	37.6	5.1 mmol/L	2

History Taking

Treatment Response

Diagnosis

This patient is suffering from mild-to-moderate dehydration secondary to heat exposure and inadequate fluid intake at a community event, presenting with headache, nausea, vomiting, tachycardia, and mildly prolonged capillary refill time.

Facilitator Triggers — if trainees miss a critical step

! (If BGL is not checked within the first 5 minutes of assessment, Lily becomes more lethargic and her GCS drops to 14 — cue the mother to say 'she seems really sleepy now, is that normal?')
! (If the trainee does not move the patient to a cool, shaded area inside or near the FAP within the first 2 minutes, increase patient's reported discomfort and advance temperature to 38.2°C)
! (If oral fluids are not offered within the first 5 minutes of assessment and patient GCS is confirmed as 15, prompt the mother to ask 'should she be drinking something?')
! (If nausea is not assessed and the trainee does not consider ondansetron, Lily vomits again at 8 minutes — facilitator cues mother saying 'she's going to be sick again')

Treatment Objectives

1. Ensure scene safety and don appropriate PPE prior to patient contact.
2. Perform Primary Survey — confirm patent airway, spontaneous breathing, radial pulse present, GCS 15.
3. Move patient to a cool, shaded environment inside or adjacent to the FAP to reduce ongoing heat exposure.
4. Perform Vital Sign Survey — record HR, RR, BP, SpO2, temperature, BGL, CRT, GCS, and pain score.
5. Perform Blood Glucose Level check — result 4.8 mmol/L, within normal range, no hypoglycaemia treatment required.
6. Assess for signs of dehydration: dry lips, tachycardia (HR 108), mildly prolonged CRT (2–3s), headache, nausea, vomiting, reduced fluid intake.
7. Assess nausea and vomiting — Lily is GCS 15 and nauseated with one vomiting episode; consider Ondansetron 4 mg oral wafer (paediatric dose for >4 years or >15 kg — Lily is 25 kg and 8 years old — dose is 4 mg oral wafer, not repeated).
8. Administer Ondansetron 4 mg oral wafer — single dose only for paediatric patients, not to be repeated.
9. If patient is GCS 15 and can safely swallow, offer oral rehydration — small, frequent sips of water or sports drink to commence rehydration.
10. Assess pain — headache 4/10; consider Paracetamol 500 mg oral (age 9–12 uses 500 mg tablets; Lily is 8 years old — use weight-based oral solution 15 mg/kg = 375 mg OR 3 × 120 mg chewable tablets = 360 mg for 6–9 year age group as per CPG).
11. Administer Paracetamol 3 × 120 mg chewable tablets (360 mg oral) — Lily is 8 years old (6–9 year bracket) — for headache, 4–6 hourly as needed, maximum 60 mg/kg/day.
12. Reassess GCS, HR, CRT, and pain score at 10 minutes — improvement expected with cooling, oral fluids, and analgesia.
13. Record all observations and interventions on ePCR.
14. Advise mother of findings and management — encourage continued oral fluid intake and to ensure Lily is kept in the shade for the remainder of the event.
15. Assess ongoing need for ambulance transport — if patient improves to HR <100, CRT <2s, GCS 15, tolerating oral fluids, and pain score reduces, non-conveyance may be appropriate with safety-net advice.
16. If condition does not improve or deteriorates (ongoing vomiting, worsening GCS, HR remains >110, or signs of heat stroke develop), arrange transport Priority 1 and pre-notify receiving facility.
17. Scenario ends on arrival of ambulance (if transported) and IMISTAMBO handover.
18. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Hypoglycaemia · Heat Stroke · Dyspnoea & Respiratory Distress · Ondansetron · Paracetamol (Panadol, Childrens Chewable Panadol) · Glucose Oral Gel (GLUTOSE, Glucogel) · Blood Glucose Monitor · Primary Survey · Pain Assessment

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Signs/Symptoms	Headache, nausea, dizziness, dry mouth, one episode of vomiting 20 minutes ago.
Allergies	Nil known drug or food allergies.
Medications	Nil regular medications.
Pertinent History	Nil significant past medical history. Nil prior episodes of this nature.
Last Oral Intake	Breakfast approximately 5 hours ago. No fluids since then.
Events Leading	Lily has been walking around the carnival in warm, sunny conditions since 10am. Mum noticed she became quieter and was sweating, then complained of headache and dizziness before vomiting once.
Treatment Prior	Nil treatment administered prior to EHS arrival.

Onset	Gradual onset over the last 2–3 hours. Vomiting began approximately 20 minutes ago.
Pain	Headache described as dull, 4/10. Mild abdominal cramps.
Quality	Dull, constant headache. Intermittent nausea.
Radiates	Nil radiation of pain.
Severity	4/10