Send home, to return if other symptoms develop

You explain to Charlie’s mother that vomiting is a very common symptom in this age group and not to be worried about this alone. The tests have not shown a specific problem and there are no abnormal findings on her examination, and being in a stressful environment like a hospital will make the vomiting worse.

You ask her to bring Charlie back if she begins to vomit more, if the vomit goes green or if she is worried by anything else.

The mother is very happy that there is nothing particular wrong with Charlie and tells you she will return if there are further concerns. Her husband takes her out of the department with Charlie soon after.

You are nearly at the end of your shift when you are called back to the emergency department. Charlie has returned.

The mother explains that she continued to vomit and this had now become greenish, but then suddenly she looked pale and unresponsive. She called an ambulance. By the time the ambulance arrived Charlie was again looking better.

In the emergency department a cannula was been sited and a 10 ml/kg fluid bolus is being given. A venous blood gas has also been taken:

pH                   7.27
pCO₂                    4.8 KPa
pO₂                  5.1 KPa
BE                   -3.5 mmol/L
Lactate            3.1 mmol/L

What would you like to do now?