Acutely Ill Child

Question 1

Amber/ intermediate risk feature 1

Answer 1

Colour of skin, lips, tongue - pallor reported by parent

Question 2

Amber/ intermediate risk feature 2

Answer 2

Activity - no smile, not responding to social cues, wakes only with prolonged stimulation

Question 3

Amber/ intermediate risk feature 3

Answer 3

Resp
Nasal flaring
Tachypnoea
RR > 50 breaths if 6-12 months / >40 if above 12 months
O2 sat <95% in air
Crackles in chest

Question 4

Amber/ intermediate risk feature 4

Answer 4

Circulation/ hydration
Poor feeding in infants
Dec urine output
Tachycardia- >160, >150 if 1-2, >140 till 5
Dry mucous membranes

Question 5

Amber/ intermediate risk feature 5

Answer 5

Age 3-6 months temp >39
Fever for>5 days
Rigors
Swelling of joint/limb
Not using a limb

Question 6

High risk 1

Answer 6

Colour - pale/ashen/blue

Question 7

High risk 2

Answer 7

Activity - no response to social cues, does not stay awake, weak cry

Question 8

High risk 3

Answer 8

Grunting
Tachypnoea - >60
Chest indrawing

Question 9

High risk 4

Answer 9

Circ + hydration = red skin turgor

Question 10

High risk 5

Answer 10

Other
Age <3months temp >38
Non blanching rash
Bulging fonatelle
Neck stiffness
Status epilepticus
Neuro
Focal seizures

Question 11

Management

Answer 11

Safety netting and follow up
Be careful with under 3 months - prematurity, co-morbidities, history of admissions

Question 12

Meningitis/ sepsis

Answer 12

Non blanching rash

Petechial -purpuric rash

Neck stiffness, drowsiness, photophobia, vomiting, fever

Non specific - refusing to feed, irritable, sleepiness

Benzyl penicillin IM

Inform public health

Question 13

Meningococcal disease features, pathogen, vaccine

Answer 13

Rapidly fatal

Initially can mimic flu

Peaks under 4yrs, 15-24yrs age groups

Caused my neisseria meningitidis - gram -ve diplococcus with oute polysaccharide capsule with antigenic types A, B, C, W-135, Y.
25% carry in nasopharynx

Can present as meningitis, meningitis and septicaemia or septicaemia alone

Purpuric rash - 40%

Vaccine against Hib, B as infant
A,C,W,Y later

Question 14

Assessment

Answer 14

ABCDE then reassess

A - look, listen and feel for airway patency. In unconscious do head tilt chin lift.

B - effort - resp rate, grunting, flaring of nostrils, accessory muscles, gasping, exhaustion.
Efficacy - chest expansion, auscultation, O2 sat, silent chest

C - hypoxia leads to tachycardia but if prolonged brady.
Cyanosis if O2 sat less than 70%
Hypoxia or hypercapnia = agitation or drowsy
Mottled skin with pale, cool peripheries

D - AVPU or GCS
Pupil size and response
Blood sugar testing

E - purpuric rash