Unwell child Flashcards
What is the UK immunisation schedule?
8 week check - 6 in 1 (diphtheria, tetanus, pertussis, polio, Hib, hep b); rotavirus, Men B
12 weeks - 6 in 1; PCV; rotavirus
16 weeks: 6 in 1; menB
1yr: hib/ men c; MMR; PCV; Men B
2-10: flu
3yr 4 months: MMR; 4 in 1 (diptheria, tetanus, pertussis, polio)
12-13 yrs: HPV (linked cervical cancer; throat and oral cancers)
14 yrs: 3 in 1 teenager booster (diptheria, tetanus, polio) and meningitis ACWY
Give a lit of notifiable diseases?
Acute encephalitis Acute infectious hepatitis Acute meningitis Acute poliomyelitis Anthrax Botulism Brucellosis Cholera COVID-19 Diphtheria Enteric fever (typhoid or paratyphoid fever) Food poisoning Haemolytic uraemic syndrome (HUS) Infectious bloody diarrhoea Invasive group A streptococcal disease Legionnaires’ disease Leprosy Malaria Measles Meningococcal septicaemia Mumps Plague Rabies Rubella Severe Acute Respiratory Syndrome (SARS) Scarlet fever Smallpox Tetanus Tuberculosis Typhus Viral haemorrhagic fever (VHF) Whooping cough Yellow fever
Who are notifiable diseases reported to?
Public Health England
How does measles present?
fever + one of:cough/ coryza/ conjuctivitis
koplik spots in mouth (white spots surrounded by red ring),
red rash (first seen on forehead and neck)
How does scarlet fever present?
group b streptococci - sore throat, headache, rash, neck and chest and scapula first. Red colour. Sandpaper texture!!!! Strawberry tongue
How does hand, foot and mouth disease present?
ulcers in mouth, hands and feet
fever and generally unwell
How does malloscum contagium present?
-skin coloured, raised, like warts:
DEscribe a ABCDE assessment of a child?
A: patent; listen stridor; secretions; snoring
—-> consider suction; airway opening manoeuvers;
B: recession; RR; oxygen sat; wheeze; nasal flare; creps; bronchial breathing; cyanosis look under tongue;
—-> consider nebs; oxygen
C: mottling - patchy. colour - ask parent; hydrated (wet nappies; mucus membrane; turgor; CRT), temp, radial pulse rate and volume; auscultate
—> fluids
D: alert; irritable; tone; fontanelles; pupil reactions (sluggish -DO; asymmetrical -SOL); limbs (movement, swelling); rash; blood sugars
→ glucose, analgesia pain, treat seizures
E: temp; exposure (rash, bleeds); focussed exam relevant systems
How does rubella present?
fever, headache, mild conjunctivitis coryzal sx rash (it may be absent, especially in young children) - initially, pink discrete macules that coalesce, starting behind the ears and on the face, spreading to the trunk and then the extremities. lymphadenopathy
What is a fever pain score?
points for child with sore throat: (score of 4+ indicates strep infection) Fever prev 24hrs Purulence on tonsils Acute - in last 3 days Inflammed tonsils No cough or coryza Sevre tonsil inflammation
What is safety netting?
Safety net → GP ask what do i expect to happen? How will I know if I am wrong? What would I do next if I am wrong about this?
Eg Fever not settling, can’t settle, way more miserable come back
Describe the green lights on the NICE traffic light system
normal colour skin; responds social cues; awake/ awakens normally; moist mucus membranes; NO red or amber signs
Describe the orange light signs of the NICE traffic light system
- pallor
- Not responding normally to social cues eg wakes only with prolonged shake
• Tachypnoea
• Oxygen saturation ≤95% in air
• Crackles in the chest
• Tachycardia
• CRT ≥3 seconds
• Dry mucous membranes
• Poor feeding in infants
• Reduced urine output
• Age 3–6 months with temperature ≥39°C
• Fever for ≥5 days
• Rigors
• Swelling of a limb or joint
• Non-weight bearing limb/not
using an extremity
Describe the red light signs of the NICE traffic light system
- no response to social cues
- pale/ mottled skin
- Weak, high-pitched or continuous cry
- Grunting
- Tachypnoea: RR >60
- Moderate or severe chest indrawing
- Reduced skin turgor
- Age <3 months, temperature ≥38°C*
- Non-blanching rash
- Bulging fontanelle
- Neck stiffness
- Status epilepticus
- Focal neuro signs
