The Sick Child

1
The Sick Child

• Simon Binks
• SpR Emergency Medicine

2
Scenario

• 5yo taken to ED
• Sudden onset fever and painful right hand
• ED Triage
• Pain R hand, s/onset, no trauma
• Generally unwell, Spots on back, Temp 39.9
• Given Calpol 2 hrs ago
• ?Soft tissue injury, unwell/pyrexia

3
Scenario

• ED SHO 2hrs later
• R hand swollen and painful for last 4hrs
• No trauma
• Has been in contact with chickenpox
• O/E
• Temp 40.1 (following Brufen 1hr ago)
• Small blanching spots on body
• ENT / ABDO clear
• No photophobia

4
Scenario Outcome

• Diagnosis Early chickenpox
• Management Home with antipyretics
• Child died 14hrs later of meningococcal
  septicaemia

5
Learning Points

• Measure and record vital signs
• Unresponsive to antipyretics
• Beware of unusual presentations
• Beware red herrings eg varicella
• Early blanching rash
• Photophobia not present in septicaemia

6
Assessment of circulation

• Pulse rate
• Pulse volume
• Capillary Refill
• Blood Pressure

7
(No Transcript)
8
(No Transcript)
9
(No Transcript)
10
(No Transcript)
11
Meningococcal Disease

• 50 people carry meningococcus in nose
• 50 of cases in UK in under 4yrs
• Teens and gt65yrs also susceptible
• Incidence 5 per 100,000 population
• 1 case every 10yrs in General Practise
• 3 cases per year through ED
• Overall mortality 10 (higher in Gp C)
• Recent fall in incidence ?related to MenC
  vaccination

12
Diagnosis

• High index of suspicion
• Meningitis
• Fever, Headache, Photophobia, Vomiting, Neck
  stiffness, Drowsiness
• Meningococcal Septicaemia
• Fever and non-blanching rash (Tumbler test)
• Purpura or petechiae?
• 30 Blanching maculo-papular rash

13
Treatment

• GPs
• Give benzylpenicillin IV if possible or IM if not
• In ED
• IV antibioitics
• IV colloid if shock
• ?IV Dexamethasone if meningitis
• PICU
• Ventilate if gt40mls/kg fliud required
• Inotropes

14
?
15
Summary

• Rare
• Unusual presentations
• High Index of suspicion
• IV Benzyl Penicillin
• ?IV fluids
• Further development of immunisations