RECOGNISE AND RESPONSE

Expose the patient

Skin lesions/rashes

Being able to describe rashes and link these to common conditions/emergencies is important (see table)

Table: Skin lesions/rashes
Example	Description		Causes
	Petechiae Micro-haemorrhage appearing as 1-2mm red, purple or brown macule		Septicaemia Bleeding disorder (including ITP)
	Purpura Bleeding into the skin (often multiple petechiae). Purpura do not blanch with pressure
	Ecchymosis A common bruise (a form of purpura)		Infection (purpura – see above) Trauma Bleeding disorder
	Macular <5mm, blanching, non-palpable lesion		Viral infection: Rubella Mesles HHV6/7 Eneterovirus Scarlet fever Kawasaki disease Drug reactions Early septicaemia
	Papular <5mm, blanching, palpable lesion
	Vesicular <5mm fluid filled, circumscribed, epidermal lesion		Varicella (chickenpox) Shingles Herpes simplex Coxackie (hand, foot and mouth)
	Bullous/Pustular >5mm fluid filled, circumscribed, epidermal lesion.  Contain clear or purulent fluid respectively		Impetigo Scalded skin syndrome
	Erythema Redness caused by vascular dilatation		Viral exanthema Burns Scalds Injuries
	Wheal (urticarial)		Allergy Anaphylaxis Idiopathic
	Angioedema
Images copyright DermNet NZ, reprinted with permission. For more information on descriptions in dermatology please visit the DermNet NZ http://www.dermnetnz.org

Check temperature 

A core temperature should always be taken.  In children the temperature should be taken using one of the following methods:

• electronic thermometer in the axilla
• chemical dot thermometer in the axilla
• infra-red tympanic thermometer

Infrared thermometer

Fever: Fever suggests an infective cause for the severely unwell child. The causes of fever are extensive. Common paediatric

Hypothermia: Young children with infection may present with hypothermia rather than fever. Hypothermia can also be caused by inadequate clothing/exposure.

EXAMINATION

History taking is covered in the paediatric history chapter of this resource

The child must be appropriately exposed to complete your examination, however, it is important to respect dignity at all times and minimise heat loss.  Once you have performed your initial assessment (and responded appropriately (primary survey) it would be appropriate to perform another more thorough examination as part of the secondary survey.  This is generally a top to bottom examination focusing into any systems examination where relevant.

This will include an examination of the major systems and identifying features such as those described in this table.

Symptoms

• Apnoea
• Breathlessness
• Chest pain
• Coryza
• Cough
• Drooling
• Feeding difficulties
• Grunting
• Hoarseness
• Stridor
• Wheeze

Signs

• Abnormal percussion note
• Acidotic breathing
• Cyanosis
• Chest wall crepitus
• Crepitations
• Grunting
• Recession
• Stridor
• Tachypnoea
• Tracheal shift
• Wheeze

Symptoms

• Breathlessness
• Drowsiness
• Feeding difficulties
• Fever
• Fluid loss
• Pallor
• Palpitations

Signs

• Abnormal pulse volume or rhythm
• Abnormal skin perfusion or colour
• Cardiac murmur
• Crepitations on auscultation
• Cyanosis
• Hepatomegaly
• Hypo- or hypertension
• Hypotonia
• Pallor
• Peripheral oedema
• Poor urine output
• Purpuric rash
• Raised jugular venous pressure
• Tachycardia OR bradycardia

 

Symptoms

• Abdominal pain
• Change in behaviour
• Change in conscious level
• Convulsions
• Fever
• Headache
• Visual disturbance
• Weakness

Signs

• Abnormal oculo-cephalic reflexes
• Abnormal posture
• Altered conscious level
• Altered deep tendon reflexes
• Altered pupil size and reactivity
• Convulsions
• Hypertension
• Meningism
• Papilloedema or retinal haemorrhage
• Slow pulse

 

Symptoms

• Fever
• Rashes
• Swelling of lips/tongue

Signs

• Angio-oedema
• Purpura
• Urticaria