I am putting this one up more to invite contributions from the community. It’s a case that has been included for our PRCC students – the guys who spend the entire third year of their four year graduate entry medical degree attached to a rural community (the so-called parallel rural community curriculum).
Time will tell whether this initiative translates to a career in rural medicine. However one thing is clear, the PRCC students are far more likely to get hands-on experience, whether it be doing minor gynae procedures, assisting at a LSCS, basics of airway management, assessment of undifferentiated patients in the ED or having own consulting sessions.
This week’s problem-based learning session is on a neonate with breathing and feeding difficulties. As an experiment, I am putting the case up and hoping that #FOAMed enthusiasts will be able to comment – because I’d love to demonstrate the power of #FOAMed to these rural students. So come on, don’t disappoint me…
Here’s the case
Hamish is 6 days old. He was born at 38 weeks as the second child to his 29 yo married mother. Antenatal course was reportedly unremarkable. Birth weight was 3 kg. He was discharged on day two after delivery, formula-fed and with an unremarkable ‘baby check’ by the obstetric RMO.
He presents to the hospital with parental concern that “there’s something wrong with my baby”. Mum reports difficulty in breathing and feeding (60ml of formula 5 x per day).
In terms of other history, birth parents and Hamish’s elder 4 yo brother are well with no medical problems. A paternal uncle died at 2 weeks of age from ‘hole in the heart’
On examination, Hamish looks ‘crook’ – he is pale, peripherally shut down. He is NOT cyanosed and appears afebrile. He is lethargic and sweaty. RR is 100 with intercostal recession HR is 150 with palpable upper limb pulses but the attending doctor reports difficulty with lower limb pulses. BP 63/40 arm, 45/30 leg. Heart sounds are dual with S3 gallop. There’s a ejection systolic murmur at the LSE grade 1-2/6. There is palpable firm hepatomegaly 4cm below costal margin.
I am interested in how the #FOAMed community would
(i) assess this child and come to a differential?
(ii) investigate and manage, from small rural hospital through to specialist centre?
(iii) what resources could be helpful along the way…
Over to you…
PLEASE COMMENT BELOW