The ED version of May 2011’s “Pearls” is available here! NICE on otitis media with effusion, inguinal hernias, measles, the child with a limp and the significance of a high anion gap. Do leave comments below.
Tag Archives: viral infections
Viral rashes
You know when you are not quite sure what the name is of the rash that a child has but you know it is not an acute emergency? I often wish I had done Latin “A” level and could come up with something credible sounding on the spur of the moment. I sent yet another “viral exanthem” child to my dermatology colleagues yesterday because I hesitated for a second too long over a possible diagnosis and lost the confidence of the parent. So today I have been educating myself. Take a look at www.dermnetnz.org for some fantastic images and information on more types of enteroviruses than you could possibly imagine existed. The site also has some self-directed learning modules on it.
There’s another site worth looking at, aimed at non-health professionals but with some quite useful photos on. Have a look at http://www.skinsite.com/index_dermatology_diseases.htm.
December PDF for the ED
This month’s emergency department version of Paediatric Pearls has information on dehydration from the NICE guideline on gastroenteritis in the under 5s, a bit on seizures and the evidence behind our reluctance to let you request chest x-rays for children. I’ve featured the NICE guideline on antibiotics for respiratory illness in primary care too as they are also relevant for the children we see in EUCC and the Emergency Department. I hope you find it helpful; I think the average length of time for each infection is useful information to be able to hand on to parents. Download December’s Paediatric Pearls here.
Bronchiolitis season
With thanks to Amutha for this article….
As winter approaches, most of us are very well aware that the bronchiolitis season is in full swing. Bronchiolitis is a lower respiratory tract infection – in the under 1s predominantly – that can cause fever, dry cough, nasal discharge and bilateral fine inspiratory creps ± wheeze. Most cases of bronchiolitis occur from November to March, when the viruses that can cause bronchiolitis are more common. It is also possible to get bronchiolitis more than once during the same winter season (1).
Treatment is largely supportive and many infants are managed at home if they are feeding adequately and do not have significant respiratory difficulty. Patients at high risk are ex-premature babies, those with congenital cardiac or respiratory diseases, immunodeficiency and babies < 3months of age (2). When seeing a child, we should focus our history and examination on risk factors, signs of dehydration and respiratory distress. This podcast provides an example of respiratory distress:
http://empem.org/2010/09/bronchiolitis-part-1-of-2/comment-page-1/#comment-294
3% of children will present with severe illness and require admission (2). Map of Medicine (http://healthguides.mapofmedicine.com/choices/map/bronchiolitis1.html) defines “severe” as those with:
- poor feeding – less than half normal intake
- lethargy
- history of apnoea
- respiratory rate above 70breaths/minute
- presence of nasal flare and/or grunting
- severe chest wall recession
- cyanosis
- marked use of accessory muscles
- marked intercostal and subcostal recession
- oxygen saturation (SaO2) 94% or less
There have been no therapies that have been consistently effective enough to change the current supportive management of bronchiolitis. The majority of trials show that bronchodilators do not provide benefit and their routine use is not recommended (3).
1.http://www.nhs.uk/conditions/Bronchiolitis/Pages/Introduction.aspx
2. Scottish Intercollegiate Guidelines Network (SIGN). Bronchiolitis in children. A national clinical guideline. Edinburgh: SIGN; 2006. http://www.sign.ac.uk/pdf/sign91.pdf
3. Petruzella FD, Gorelick MH. Current therapies in bronchiolitis. Pediatr Emerg Care 2010 Apr;26(4):302-7