An 8-year-old female has been brought into the emergency department by her mother. The mother is hysterical screaming, “Somebody help my baby!” The nurse asks the mother what happened and the mother yells back, “I don’t know, you are supposed to tell me! She is not herself! Fix her!” The nurse takes a set of vital signs and notes they are all within normal limits except a temperature of 100.3°F. The child however, is struggling to keep her eyes open or answer any questions. All of a sudden the child vomits.

The child is no longer vomiting and is placed on their side to avoid aspiration. The nurse has two nurse assistants and another nurse. The patient needs an IV, blood draw, POC glucose test, anti-nausea medication and an assessment.

The lab work comes back and the patient has a high WBC count, elevated ammonia, and positive salicylates. The patients’ glucose is 33. The patient is lethargic, pupils (+2) are equal, round, and sluggishly reactive. The capillary refill is less than 3 seconds, cardiac heart sounds S1 and S2 are auscultated, lung fields are clear, breathing is even, shallow and non-labored. The mother has finally calmed down enough to answer questions.

The mother says that she was at work and the babysitter who is 15 said she gave her something to help her fever but she doesn’t know what. According to the mother the child has been not feeling well lately, and has been experiencing N/V/D and a low grade fever for 2 days.