Paediatrics Flashcards
ABCDE approach to a child
Airway:
Listen for stridor
Assess for foreign body or secretions (drooling, look in throat, XR)
Breathing:
watch for 30 seconds-1 minute for RR
Recession (subcostal, intercostal, sternal), nasal flaring, tracheal tug, accessory muscle use
Oxygen saturation (<94 significant illness, <90 alarming)
Auscultation (wheezing, crepitations in bronchiolitis, bronchial breathing)
Circulation:
Colour: pallor, mottled
Radial pulse rate (brachial for <6 months) (>160bpm for 1 YO, >150 for 1-2 years and >140 for 2-5 YOs)
Hydration signs: wet nappies, mucous membranes, skin turgor, capillary refill and peripheral temperature of hands and feet
Auscultate heart sounds
Blood pressure if very unwell
Disability (neuro): Alertness and activity Responsive to surroundings Behaviour (irritable, clingy), distinguish from true irritability (sign of raised ICP) by if the child can be distracted or consoled at all. If they cannot it is likely more true irritability. AVPU score/Glasgow Coma Scale Pupils if very unwell Limb tone and movement Joint swelling RASHES Capillary glucose if decreased alertness
Everything else:
Ears, Nose, Throat exam: ensure positioning of child is appropriate and parents secure them safely
Temperature: measure with tympanic membrane thermometer or tempa dot strip or axilla (recommended for babies)
Feel stomach for tenderness, organomegaly, masses etc.
Green features of traffic light system and management
Responds normally to social cues
Content and smiling
Stays awake or wakes quickly
Strong, normal crying
No red or amber symptoms
Circulation and hydration
Normal skin and eyes
Moist mucous membranes
No amber or red symptoms
management:
Supportive care advice
Safety netting for worsening symptoms and when to phone back/attend A+E
orange features of traffic light system
> 39 degrees in children aged 3-6 months
Pallor reported by parents
Not responding normally to social cues
No smile
Wakes only with prolonged stimulation
Decreased activity
Nasal flaring
Tachypnoea >50 in ages 6-12 months or >40 in >12 months
Oxygen saturation <95% on air
Crackles in chest auscultation
Tachycardia >160bpm ages <12 months
>150bpm in ages 12-14 months
>140 bpm in ages 2-5 years
Cap refill >3 seconds
Dry mucous membranes
Poor feeding in infants
Reduced urine output
Age 3-6 months
Temperature >39
Fever for >5 days
Rigors
Swelling of limb or joint
Non-weight bearing limb/not using an extremity
management:
Safety netting advice for parents to be managed at home (clinical judgement)
Advice on warning symptoms and when to following up for urgent medical review
Arrange primary care review/follow-up
Liaise with other healthcare professionals, including out of hours, to ensure direct access for the child if further assessment is needed
Consider hospital admission if:
Age <3 months with suspected unexplained UTI
Feverish illness with no obvious cause, unwell for longer than expected
Significant parent anxiety or difficulty coping
Red features of traffic light system and management
> 38 degrees in infants aged 0-3 months
Hypothermia
Pale
Mottled
Ashen or cyanotic
No response to social cues
Appears ill to healthcare professional
Does not wake or stay awake if roused
Weak, high pitching or continuous crying
Grunting
Tachypnoea >60
Moderate or severe chest indrawing
Reduced skin turgor
Age <3 months with temperature of >38
Non-blanching skin rash
Bulging fontanelle
Neck stiffness
Status epilepticus
Focal neurological signs
Focal seizures
management:
Urgent transfer to hospital
fever
Background:
Elevation of body temperature above daily normal variation (>37-38 degrees C usually)
Very common presentation in children in primary and secondary care
Fever in young children >6 months are often not serious
Fever in children aged 3-6 months have a higher chance of being serious and must be taken seriously
Fever in a child <3 months is unusual and concerning - requires hospital admission for Ix
Aetiology:
Viral infections (most common)
Bacterial infection - meningitis
Non-infectious cause - Kawasaki disease (fever >5 days)
fever presentation and investigation
Presentation:
Temp >37 degrees
Symptoms of causative agent (infection or systemic signs)
Investigation/diagnosis:
Traffic light system
Assess age: 1+ (green), 6-12 months (orange), <6 months (red)
Assess risk: prematurity, cardiac disease, syndromal
History - assess parental perception and child’s presentation/history, associated symptoms of D+V, rash, maternal fever/premature delivery, significant medical conditions, immunosuppression, recent antipyretic drug or antibiotic use
Immunisation history !!
Recent foreign travel, recent contact with serious infectious diseases, parental beliefs or previous experiences or severe febrile illness.
fever management
Management:
Antipyretics to help reduce fever and improve symptoms (DOES NOT HELP CAUSE) such as calpol, paracetamol or ibuprofen
Avoid overwrapping or undressed clothing, avoid tepid sponging, encourage fluid intake
Fever in young children >6 months are often not serious
Fever in children aged 3-6 months have a higher chance of being serious and must be taken seriously
Fever in a child <3 months is unusual and concerning - requires hospital admission for Ix
Red column - urgent hospital admission
acute cough
Background:
Very common in young children especially in URTIs
Usually <3 weeks for infection (acute)
Very uncommon to have a chronic cough in young children (passive smoking)
Aetiology:
Most commonly viral infection
Infants under 12 months - often bronchiolitis
acute cough presentation, investigation and management
Presentation:
Cough
Can be characteristic such as whooping cough (pertissus) or barking cough (croup)
Can be with or without a wheeze or chest sounds
Investigation/diagnosis:
ABCDE for respiratory distress
ENT exam (aside from if epiglottitis is suspected)
Vital signs - oxygen, temperature, cap. Refill,
Assess for other symptoms - chest, hydration, cap. Refill, skin turgor, low urine output, poor feeding or wet nappies
Home life symptoms - pets, passive smoking, fumes
Management:
Asthma symptoms - SABA inhaler via spacer, hospital admission if severe respiratory distress
Hospital admission for temp >38 in ages <6 months, inadequate fluid intake (<50% normal), decreased activity, <3 months with cough and fever (croup)
Diarrhoea and vomiting
Background:
Very common in children, often caused by gastroenteritis, often children have more than one episode per year
Pathology:
Depends on underlying cause
Gastroenteritis - upper gastrointestinal tract infection (stomach and intestines)
Aetiology:
GI infections (gastroenteritis) most commonly from viral infections (rotavirus or norovirus) or bacterial (E. coli, campylobacter, shigella)
Systemic infections
Surgical conditions (intussusception, pyloric stenosis)
Diarrhoea and vomiting presentation, investigation and management
Presentation:
Gastroenteritis - diarrhoea usually lasting 5-7 days, most resolve within 2 weeks, vomiting for 1-2 days, most stop within 3 days
Investigation/diagnosis:
Dehydration assessment
vitals
Management:
Gastroenteritis - self limiting, supportive care, replacement fluid intake to prevent dehydration
Oral rehydration solution for those at risk of dehydration
IV fluids only for persistent vomiting of oral rehydration solution or suspected shock
Encourage small regular foods, avoid solids unless dehydration is normal
intussusception
Background:
Primary - 95% of infants and children, usually ages 3-12 months
Secondary - in adults, much less common.
Mortality is very low within the first 24 hours but very high in irreducible or gangrenous cases
Complications - ischaemia of the bowel, risk of gangrene or necrosis, bowel obstruction if involved loops become blocked.
Pathology:
Telescoping prolapse of a portion of intestine into the lumen of the adjacent portion of intestine
Aetiology:
Primary - has no obvious cause, disharmony between ileum and cecum in GE
Secondary - underlying cause present such as polyps, inverted Meckel diverticulum etc.
Risk factors: Ages 3-12 months (primary) Males 2:1 (primary) Meckel's diverticulum Polyps
intussusception presentation and investigations and management
Presentation:
Paroxysms of abdominal colic (screaming and pallor, leg raising, with intermittent settling between bouts of pain)
Bilious vomiting from obstruction
Red-currant jelly stool (late sign)
Dance’s sign - empty RIF + sausage shaped mass in mid abdomen or RUQ
Signs of shock - lethargy, poor feeding, hypotonia
Investigation/diagnosis:
USS diagnostic showing target or doughnut sign in cross section
Management:
Obstruction - NMB, nasogastric tube feeding, IV fluid resus before attempting reduction
Air enema - diagnostic and therapeutic
Operation - gentle reduction or resection if irreducible or gangrenous
constipation
Background:
Very common paediatric problem
Encopresis - faecal incontinence, not considered pathological until 4 years of age. It is usually the sign of chronic constipation where the rectum becomes stretched and loses sensation. Large hard stools main remain in the rectum and only loose stools are able to bypass the blockage and leak out
Pathology:
less bowel peristalsis leading to less bowel movements
Hard stools leading to difficulty passing
Aetiology:
Most are idiopathic or functional constipation - no significant underlying cause other than lifestyle factors
Secondary - Hirschsprung disease, CF, hypothyroidism
Encopresis - faecal impaction, spina bifida, hirschsprung disease, CP, learning disability, psychological stress, abuse
constipation risk factors and presentation
Risk factors: Habitually withholding stools Low fibre diet Poor fluid intake and dehydration Sedentary lifestyle Psychological problems (safeguarding)
Presentations: Very variable between individuals < 3 x weekly Hard stools, difficult to pass Rabbit dropping stools Abdominal pain Straining and painful passage Rectal bleeding associated with hard stools Holding abnormal posture (retentive posturing) Faecal impaction - overflow soiling with incontinence of loose and smelly stools Palpable mass in abdomen Loss of sensation of need to open bowels
constipation investigations and management
Lifestyle factors history
History for RED FLAGS:
Not passing meconium within 48 hours of birth (CF or hirschsprung’s disease),
Neurological signs or symptoms (cerebral palsy/spinal cord lesion),
Vomiting (intestinal obstruction or Hirschprung’s)
Ribbon stool (anal stenosis)
Abnormal anus, abnormal lower back or buttocks
Failure to thrive (coeliac disease, hypothyroidism, safeguarding)
Acute severe abdominal pain and bloating (obstruction or intussusception)
Management:
Recommend high fibre diet and good hydration
Start laxatives (movicol first line), continue long term and slowly wean off as good bowel habits develop
Faecal impaction - disimpaction regimen with high dose laxatives then taper off
Encourage and praise good toilet habits to improve habits
Bowel diary
Encephalitis
Background:
Inflammation of the brain, causing abnormal cerebral function (unlike meningitis)
Encephalitis - preceded by an infectious prodrome (temperature, rash, LAP, cold sores, conjunctivitis, meningeal signs)
Encephalopathy - no infectious prodrome e.g. hypoglycemia, hepatic encephalopathy, DKA, hypoxic brain injury, uremia, drugs, SLE, wernicke’s etc.
Pathology:
Inflammation of the brain often causing cerebral abnormality leading to altered mental status, motor and sensory deficits
Aetiology:
Usually viral (HSV 1-2, arboviruses, CMV, VZV, HIV, Measles, mumps, rabies, japanese B encephalitis, west nile virus, tick-borne encephalitis etc.)
Non-viral - bacterial meningitis, TB, malaria, listeria, lyme disease, legionela, leptospirosis, aspergillosis, cryptococcus, schistosomiasis, typhus.
Risk factors:
Meningitis
Immunocompromised
encephalitis presentation and investigation
Presentation: Altered personality Decreased GCS score Confusion drowsiness, coma Fever Headaches Neck stiffness and pain Seizures Focal neurological signs History or travel or animal bites Infectious prodrome (temperature, rash, LAP, cold sores, conjunctivitis, meningeal signs)
Investigation/diagnosis:
GCS score
ABCDE assessment
Bloods - cultures, viral PCR, U+Es,
Contrast enhanced CT (before LP), or MRI if allergic to contrast
LP - typically moderate protein and lymphocyte increase, decreased glucose
EEG
encephalitis management
Management:
Hospitalisation
IV Acyclovir within 30 minutes of arrival for 14 days (empirical treatment for HSV)
Specific therapies for CMV (ganciclovir), toxoplasmosis based on blood cultures or PCR
Supportive therapy in HDU/ICU
Phenytoin for seizures, treat increased ICP
Repeat LP to ensure successful treatment prior to stopping antivirals
Complications - high ICP, seizures, mortality is 70%
meningitis
Background:
Infection of the meninges, usually bacterial
Associated with high mortality
Complications - VTE, severe cerebral oedema or abscess, hearing loss, seizures and epilepsy, cognitive impairment, memory loss, cerebral palsy with FNDs (limb weakness, spasticity)
Viral - usually benign, self-limiting within 4-10 days with no serious sequelae
Chronic meningitis - long history of vague symptoms (headache, lassitude, anorexia, vomiting, signs of meningism later in disease
Pathology:
Microorganisms infect the meninges from the ears, nasopharynx, cranial injury, congenital defects leading to inflammation
Infection may spread to the blood leading to septicemia
Aetiology: MPH
Most commonly meningococcus (neisseria meningitidis), Pneumococcus (strep. pneumonia) or Haemophilus influenzae worldwide
Viral - enterovirus, polio, mumps, HSV, epstein-barr virus
Fungal infection
meningitis risk factors and presentation
Risk factors:
Cranial injury
Infection
Immunocompromised
Presentation:
Headache
Neck stiffness (nuchal rigidity) - Brudzinski’s neck sign
Fever
Photophobia
Vomiting
Kernig’s sign (inability to fully extend the knee when the hip is flexed 90 degrees)
Papilledema
Meningococcal septicaemia - non-blanching, purpuric skin rash (starts as small pin pricks spreads quickly and turns into red/purple blotches), signs of shock (tachycardia, tachypnoea, hypovolemia)
Complications - progressive drowsiness, lateralizing signs, cranial nerve lesions
meningitis investigations
Rash - glass test for blanching
ABCDE assessment
GCS score
Bloods - cultures (CONFIRMS BACTERIAL SEPSIS), viral PCR, syphilis serology, U+Es, LFTs
CXR
Contrast CT for FND, papilloedema,, LOC or seizures (before LP to exclude high ICP)
LP - diagnostic CSF microscopy (DO NOT PERFORM IF BACTERIAL SEPSIS SUSPECTED)
meningitis LP results
Normal - clear, <5 white cells, all lymphocytes, 0.2-0.4 protein, normal pressure 10-20
viral - clear, 5-1000 white cells, lymphocytes, 0.4-1 protein, normal or slightly high opening pressure
bacterial - cloudy and turbid, 100-50,000 white cells, neutrophils, >1 proteins, <40% plasma glucose, high opening pressure
TB - cloudy and viscous, <500 white cells, lymphocytes, 1-5 protein, <30% plasma glucose, high opening pressure
meningitis management and prophylaxis
All cases must be notified to local public health authority allowing contact tracing
Non-blanching rash:
Immediate hospitalisation
Benzylpenicillin 1200mg slow IV or IM OR cefotaxime 1g IV before transfer to hospital
Start IV antibiotics once admitted, tailor to blood culture results
Mx:
Ideally perform LP to confirm before starting ABX but this should not delay ABX
<3 months - Cefotaxime 2g/6 hourly initially + amoxicillin (covers listeria contracted during pregnancy)
Above 3 months old - ceftriaxone
Change ABX based on cultures, vancomycin for penicillin resistance
Steroids for bacterial meningitis to reduce loss of hearing and neurological damage (DEXAMETHASONE give 4x daily for 4 days to children >3 months)
IV fluids and inotropes for septicaemia signs
Prophylaxis:
Oral rifampicin or ciprofloxacin to eradicate nasopharyngeal carriage of organism
Given to those with prolonged contact with infected patient in household setting during 7 days prior to illness onset
Vaccine for meningococcal group C and haemophilus influenzae is part of routine UK childhood immunisation
stridor
Background:
Noise heard on inspiration, from partial obstruction at the larynx or large airways
More common in children as their airways are narrower and more flexible than adults, meaning obstruction occurs more dramatically and faster.
Pathology:
Partial obstruction of the larynx or large airways causing whistling high pitch notes on inspiration due to the decreased diameter of the airway passage.
Aetiology:
Infective - croup (laryngotracheobronchitis), bacterial tracheitis, epiglottitis, laryngitis
Non-infective - congenital (laryngomalacia, web/stenosis, vascular rings), anaphylaxis, haemangiomas or papillomas, thermal or chemical trauma, foreign body or vocal cord paralysis.
stridor presentation and other signs of respiratory distress
High pitched, wheezing, musical sound on inspiration
Other signs of respiratory distress:
Swallowing difficulty/drooling
pale/cyanosed
Accessory muscle breathing
Nasal flaring
Subcostal retraction/recession (indrawing of the abdomen just below rib cage, belly breathing)
Downward plunging of trachea with respiration (tracheal tug)
stridor infective and non-infective differentials and investigations
infective:
croup
epiglottitis
bacterial tracheitis
retropharyngeal abscess
non-infective:
inhaled foreign body
subglottic haemngioma
C1 esterase inhibitor deficiency (hereditary angioedema)
hypoglycaemia
investigations ABCDE examination Vital signs - temp, RR, HR, breathing Respiratory examination Bloods - U+Es, Ca, FBC
croup/laryngotracheobronchitis (LGB)
Background:
Leading cause of stridor with a barking cough
Most severe in children under 3 years old (typically 6 months - 2 years)
Pathology:
Viral upper respiratory tract infection causing inflammatory oedema involving the larynx, causing a hoarse voice and barking cough and partial airways obstruction leading to stridor.
Aetiology:
95% viral - parainfluenza, influenza, adenovirus, respiratory syncytial virus (RSV), measles etc.
Bacterial - klebsiella, diphtheria (rare, can lead to epiglottitis)
Fungal - rare
Risk factors:
Ages 6 months - 2 years
croup presentation, investigation and management
Presentation:
Stridor and barking cough with no drooling - almost always croup
Increased work of breathing
Barking cough occurring in clusters of coughing episodes
Hoarse voice
Stridor
Low grade fever
Steeple sign - tapering trachea seen on XR
Investigation/diagnosis: ABCDE examination Respiratory examination Vital signs CXR
Management:
Mild
Generally self-limiting, within 48 hours should improve (parainfluenza viral infection especially),
Supportive treatments (fluids and rest), sit them up during coughing and comfort, avoid school while ill and vulnerable people.
Good hygiene to avoid spreading.
Any child under 6 months with signs of difficulty breathing or dehydration must be admitted to hospital
Moderate - severe - admit to hospital
Dexamethasone (prednisolone in GPs) 150 mcg/kg can be given orally and repeated again in 12 hours PRN
Supportive oxygen
Nebulised budesonide 2 mg
Nebulised adrenaline (failure to improve with steroids or adrenaline - consider bacterial tracheitis)
Intubation and ventilation
bacterial tracheitis
Background:
Pseudomembranous necrotising tracheitis
Most serious in young children due to relatively small sized trachea, easily blocked by swelling.
A severe bacterial infection of the trachea capable of producing airways obstruction
Usually considered part of the lower respiratory tract however can produce upper airway obstruction if severe.
Pathology:
Thick mucopurulent exudate and tracheal mucosal sloughing (pseudomembrane) that is not able to be cleared with coughing and risks occluding airway
Defects in the cartilage leads to inability to support the trachea, collapse of the trachea due to hacking or barking cough
Aetiology:
Most commonly staph aureus
Often follows recent viral URTI
bacterial tracheitis presentation and investigation
Presentation: Often history of a recent URTI with an acute deterioration Toxic appearance Barking cough with thick sputum Inspiratory stridor Scratchy feeling in throat Tracheal tenderness Chest pain Fever Earache, headache, dizziness Increased effort to breathe (accessory muscle use, stridor, grunting, nasal flaring)
Investigation/diagnosis:
ABCDE assessment
Respiratory examination - rule out croup and epiglottitis
Bronchoscopy for direct vision of exudates or pseudomembrane on trachea
CXR - subglottic narrowing
Vital monitoring
ECG monitoring during treatment
bacterial tracheitis management
Severe:
IV antibiotics (broad spectrum)
ITU/ICU admission for intubation and supportive ventilation
ECG monitoring, oxygen saturation, capnography, BP monitoring
epiglottitis
Background:
Rare but has high mortality rate due to risk of respiratory arrest
Medical emergency
Pathology:
Bacterial URTI leading to inflammation and swelling of the epiglottis
This can potentially cause airway obstruction
Aetiology:
Haemophilus influenzae type B most commonly
Strep pyogenes
Risk factors:
M:F 3:1
Peak age of infection is 2-7 years
epiglottitis presentation and investigation
Presentation: Often acute history of infection Sore throat Drooling (head forward, tongue out) Prefer to sit, leaning forward (tripod position) Fever Dyspnoea Stridor Hot potato muffled voice Dysphagia Tender anterior neck Enlarged anterior neck nodes Voice hoarseness Thumb sign seen on lateral XR of neck
Investigation/diagnosis:
ABCDE assessment
Vitals examination
Lateral neck XR - thumb sign + exclude foreign body
Nasopharyngeal intubation by anaesthetist to diagnose
Bloods - culture
Epiglottis culture
DO NOT EXAMINE THE THROAT - CAUSES RESP> ARREST
epiglottitis management and prognosis
Management:
Prevention - vaccine programme against haemophilus
DO NOT DISTRESS PATIENT - can cause airway closure
ITC admission, alert senior paediatrician and anaesthetist to secure airway
Oxygen by mask until anaesthetist arrives
Nebulised adrenaline
IV dexamethasone
Nasopharyngeal intubation by anaesthetist to diagnose
IV pen G + ceftriaxone 2g/12 hourly
Antipyretic (ibuprofen)
Cricothyrotomy in emergency
Prognosis:
Most recover without intubation
Those that are intubated often recover fully within a few days
Common complication is epiglottic abscess, collection of pus around the epiglottis which also threatens the airways. Treatment is similar to epiglottitis.
eczema
Background:
Chronic relapsing inflammatory condition of the skin
Complications - lichenification, secondary infection, refractory eczema
Pathology:
Excessive skin growth leading to immature keratocytes on outer skin layers and improper laying of keratocytes leads to improper skin barrier formation
Leads to excess loss of water and skin buried defects allowing pathogens etc. to enter
This leads to skin inflammation and easy irritation
The itch, scratch cycle is when inflammation causes itching, the patient scratches the area and this leads to further histamines release in the tissues causing increased itch and so on.
Aetiology:
Unknown
Triggers - heat, allergens, infection, sweating, severe stress
Risk factors:
Personal history of atopic conditions - asthma, hay fever, eczema
Familial history of atopy
eczema presentation, ix, mx
Presentation: Itchy Erythematous Dry, scaly patches May weep Nail pitting and ridging Commonly on extensor aspects (INFANTS) or flexor aspects (CHILDREN and ADULTS)
Investigation/diagnosis:
Clinical - itch + history of atopy, general dry skin, visible eczema rash, onset in first 2 years of life
Management:
Avoid triggers, keep nails short and avoid scratching (educate on itch scratch cycle)
Apply emollient liberally (thin creams - e45, aveeno, thick creams - 50:50 ointment, hydromol, cetraben ointment)
Topical hydrocortisone 7 days for flares
Antihistamines
Antibiotics (flucloxacillin) for secondary infection
Later life - tacrolimus (ages 2+) or pimecrolimus (ages 2-16)
Phototherapy and immunosuppressants for severe cases
steroid ladder
Mild = hydrocortisone
Mod = eumovate
Potent = betnovate
Very potent = dermovate
nappy rash
Background:
Very common in young children wearing nappies
Common complication is secondary yeast infection with candida species
Severe long standing nappy rash can lead to erosions and ulcerations
Pathology:
Contact dermatitis +/- secondary candida infection
Inflammation of the skin in response to urine and faeces contact
Aetiology:
Prolonged wearing of soiled nappies
Risk factors: Most common between ages 9-12 months Not regularly changing infant Not washing or drying well/using talcum powder Tight fitted nappies
nappy rash presentation, ix and mx
Presentation: Sore, itchy Erythematous Spread around the nappy region only (perianal, genital region) Tends to spare the skin creases Worsened after wearing nappies Improves with less nappy use Candida - rash extending into skin folds, well demarcated scaly border, circular pattern to rash, satellite lesions near main rash.
Investigation/diagnosis:
Clinical
Swab for resistance or uncertainty
Management:
Leave nappies off for as long as possible
Change regularly, use barrier emollient creams liberally
Talcum powder after washing to help properly dry the area
Loose fitting nappies to avoid irritation
Mild hydrocortisone cream for 7-14 days for inflammation
Daktacort cream (miconazole + hydrocortisone) or antifungal cream for suspected candida infection 2-3x daily for 7-10 days after the rash clears
eczema herpeticum
Background:
Viral herpes simplex or VZV skin infection in those with atopic dermatitis
Pathology:
Atopic dermatitis leads to poor skin barriers in some areas making contact with viral lesions easier for spreading and causes more widespread severe skin flare up
Aetiology:
Most commonly HSV-1 or VZV
Risk factors:
Atopic dermatitis
eczema herpeticum presentation, ix and mx
Presentation: Widespread, painful, vesicular rash - affects any area Pus filled vesicles, sometimes itchy After bursting, leave punched out ulcers with red base Fever Lethargy Irritability Reduced oral intake LAP
Investigation/diagnosis:
Clinical diagnosis
Viral swabs to confirm
Management:
Aciclovir (oral for mild-mod or IV if severe)
Complications - bacterial superinfection needing antibiotics
Hand foot and mouth disease and presentation
Background:
Complications - dehydration, bacterial superinfection, encephalitis
Pathology:
Incubation usually 3-5 days
Viral infection transmitted via lesion contact or respiratory droplets
Aetiology:
Coxsackie A virus
Presentation:
URTI - fatigue, sore throat, dry cough, fever
After 1-2 days small mouth ulcers appear followed by blistering red spots across the hands, feet and mouth mostly
Painful ulcers, particularly on the tongue
May be itchy
hand foot and mouth disease ix and mx
Investigation/diagnosis:
Clinical diagnosis
Dehydration status
Management:
Supportive - good fluid intake, simple analgesia and antihistamines if itchy or painful
Spontaneously resolves within 7-10 days
Educate on high transmission - avoid sharing towels, bedding, wash hands regularly especially when handling dirty nappies
chicken pox
Background:
Complication: chickenpox induced pneumonia, bacterial superinfection, dehydration, conjunctival lesions, encephalitis/ataxia
Do NOT use NSAIDs as this worsens the rash and symptoms
Pathology:
Highly contagious, spread via direct contact with lesions or infected respiratory droplets
Patients become symptomatic 10 days - 3 weeks after exposure
Stops being contagious after lesions have crusted over
After viral infection presents, virus can lay dormant in sensory dorsal root ganglion cells and cranial nerves which can reactivate later in life as shingles or ramsay hunt syndrome
Aetiology:
VZV infection
chicken pox presentation
Presentation:
Vesicular, raised rash, widespread
Erythematous
Blistering lesions
Usually starts on the trunk or face and spreads outwards over 2-5 days
Eventually lesions scab over and stop being contagious
Fever
Itch
General fatigue and malaise
In pregnancy <28 weeks can cause congenital varicella syndrome
In pregnancy around time of delivery can cause life threatening VZV infection
