Case Study You are working in the

Case Study You are working in the emergency department when a 12-year-old boy presents with chest pain and shortness of breath. History includes 4 days of cold and cough symptoms. He has missed a week of school and states that he has no energy despite being inactive; the patient is an athlete, so he is generally very active. He has been well except for a viral infection during the winter and has no previous history of asthma or other health issues. His mother is very concerned about his breathing and pain. PAT assessment is completed with abnormal findings for appearance, breathing, and circulation. Vital signs are taken: heart rate is 135 beats per minute, respiratory rate is 45 breaths per minute, blood pressure is 90/65 mm Hg, temperature is 38.0°C, and oxygen saturation is 89% on room air. Patient appearance is thin and pleasant in nature; he can speak in complete sentences without difficulty. He has tachypnea with mild retractions. He is slightly pale in color with dusky nail beds, capillary refill >2 seconds. Initial assessment: • A: Patent • B: Intermittently shallow and rapid respiratory rate • C: Pale; pulse rapid, thready, and weak • D: Awake/alert, GCS 15 • E: No signs of injury 1. What is your general impression of this patient? 2. What are your initial management priorities and important next actions? Oxygen by nonrebreathing mask at 12 L/minute was initiated. A cardiac monitor and an IV were placed, and blood was drawn for laboratory analysis. A chest radiograph revealed cardiomegaly and prominent vasculature. Laboratory studies were nonspecific. The echocardiogram revealed poor cardiac contractility. It is thought that he may have an acquired cardiac problem due to secondary myocarditis from his winter illness. 3. What is your impression of this patient now? Two weeks later he recovered and was sent home. He will need to be monitored in the future to assess cardiac function.

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