A Four-Year-Old with History of Kawasaki Disease Presenting in Acute Shock

Abstract

We present a case in which emergency medical services (EMS) intervened on a critically ill child with known giant coronary aneurysms as sequela to her severe complicated Kawasaki disease. This patient’s severe shock ultimately ended in cardiac arrest and death. We discuss the keys to recognition, and critical importance to early intervention of pediatric shock in prehospital care. We also detail the cardiac ramifications of Kawasaki disease, steps for prompt identification of high risk complaints in these patients, and opportunities for treatment.

Key words:

• pediatric cardiac arrest
• pediatric chest pain
• Kawasaki disease
• coronary aneurysm
• Juvenile Idiopathic Arthritis
• chest pain

Notes

1 In San Diego, a base hospital system is utilized to communicate incoming patient information and provide online medical direction. Base hospitals have mobile intensive care unit nurses (MICNs) who coordinate ambulance transport locations, manage prehospital protocol variances, and can consult with and bring a physician to the radio for direct medical oversight. The satellite hospitals, which include the only children’s hospital in the region, are notified of advance life support level transports via the base hospitals and do not have direct communication with the transporting agency.