Clinical approach to the sick child Flashcards
What are the predominant infectious causes of death in neonates?
Neonates > 1 month
- Sepsis
- neonatal pneumonia
- tetanus
- neonatal diarrhoea
What are the predominant infectious causes of death in children?
Children (1-59 months)
- diarrhoea
- pneumonia
- malaria
- meningitis
- AIDS
- measles
- pertussis (whooping cough)
What is the most common clinical sign of PID in children?
PID = paediatric infectious disease
fever is most common Sx
This can be a diagnostic challenge, difficult to isolate cause (viral/bacterial)
What the common clinical syndromes for PID?
- URTIs
- Diarrhoea and vomiting
- Fever and rash
- fever (of unknown cause)
What are the most common bacterial infections in children?
- pneumonia
- septicaemia (meningococcal)
- UTI
- Meningitis
How do you perform an assessment of an unwell child?
- ABCD
- measure and record vital signs
- assess for signs of dehydration
- Use traffic light system
- Signs and Sx of specific diseases
What are the 3 categories in the NICE traffic light system of assessing a child for serious illness? What categories are assessed?
Green - low risk
Amber - intermediate risk
Red - high risk
Colour (of skin, lips to tongue) Activity Respiratory Circulation and hydration Other (Age, fontanelle, seizures etc)
What is important to remember when looking at paediatric viral sign reference ranges?
Each age category is likely to have its own reference range
e.g. neonates vs. school age children
In the traffic light system, what are the main observations in GREEN?
Green = low risk
COLOUR
- Normal colour of skin, lips and tongue
ACTIVITY
- Responds normally to social cues
RESP
- RR within normal ranges, no distress
HYDRATION
- Normal hydration in skin and eyes, moist membranes
OTHER
- No amber or red signs
In the traffic light system, what are the main observations in AMBER?
Amber = intermediate risk
COLOUR
- Parent reports pallor
ACTIVITY
- Not responding to normal social cues
- wakes only with prolonged stimulation
- decreases activity
- No smile
RESP
- Nasal flaring
- Tachypnoea: RR>50 (6-12 months); RR>40 (in >12mo)
- O2 sats < 95% in air
- Crackles
HYDRATION
- Dry mucus membranes
- poor feeding
- CRT > 3s
OTHER
- Fever > 5 days
- Limb/Joint swelling
- non-weight bearing
- new lump >2cm
In the traffic light system, what are the main observations in RED?
Red = high risk
COLOUR
- pale/mottled/ashen/cyanosed colour
ACTIVITY
- no response to social cues
- unable to rouse or if roused, not able to stay awake
- weak, high pitched or continuous cry
RESP
- grunting
- tachypnoea > 60
- moderate or severe chest indrawing
HYDRATION
- reduced skin turgor
OTHER
- Temp > 38 (0-3mo)
- Temp > 39 (3-6mo)
- non-blanching rash
- bulging fontanelle
- neck stiffness
- status epilepticus
- focal neurological signs
- focal seizures
- bile-stained vomit (bilious)
What are the specific Sx associated with meningitis?
neck stiffness
bulging fontanelle
reduced consciousness
convulsive status epilepticus
What are the specific Sx indicative of meningococcal disease/septicaemia?
non-blanching rash, particularly in combination with:
- unwell child
- lesions > 2mm in diameter (purpura)
- CRT > 3s
- neck stiffness
What are the specific Sx of herpes simplex encephalitis?
Caused by HSV
- focal neurological signs
- focal seizures
- reduced consciousness
What are the specific Sx of pneumonia?
- tachypnoea
- crackles
- nasal flaring ± chest indrawing
0 O2 sats < 95%
What are the specific Sx of UTI?
For > 3mo
- vomiting
- poor feeding
- lethargy and irritability
- abdo pain and tenderness
- frequency or dysuria
- offensive urine or haematuria
What are the specific Sx of septic arthritis/osteomyelitis?
- Limb/joint swelling
- reduced use of extremity
- non-weight bearing
Why is it important to correctly Dx rashes in children?
- prevent important exposures
- allows important/timely interventions
- understanding epidemiology
- avoiding labelling as drug allergy
How can paediatric rashes be classified?
- maculopapular vs. vesicular
- viral vs bacterial vs other cause
What are associated red flag Sx of a rash in children?
- septic signs
- fever
- irritability
- petechial rash
- blisters
What are common causes of a maculopapular rash in children?
measles
rubella
erythema infectiosum
What are the potential complications of a measles infection?
Otitis media (5-15%)
Pneumonia (5-10%)
post-infectious measles encephalitis
Persistent diarrhoea (w protein-losing enteropathy)
Acute vitamin A deficiency
xerophthalmia (accounts for much of preventable childhood illness)
case-fatality (5-10%)
What is xerophthalmia?
abnormal dryness of conductive and cornea and eye
inflammation
typically associated with vitamin A deficiency
