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Paediatrics Presentation

Fever & Rashes in Paediatrics

Last Updated on May 18, 2022

Triaging in ED

Primary triage

GCS?
• The child is in dehydration/ shock / life-threatening condition?
Infectious or non-infectious condition?

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💡 One the most important things at triage level is to determine whether the child is stable

Differential Diagnoses

Some common causes:

Infectious:
• Hand, foot and mouth disease
• Measles
• Herpes simplex virus infection
• Chikungunya
• Chickenpox

Non-infectious:
• Meningitis
• Stevens-Johnson syndrome /
• Dengue
• Kawasaki disease

History Taking

Rash

Onset of rash in relation to fever
• Type of rash
• Distribution
Spread / Progression of rash

Relevant history

• Sick contact?
• Allergy history
• Recent history of taking new medications

Physical Examination

Assessment of hydration status:

Parameter

No / Mild dehydration (≤ 5%)

Moderate dehydration (5 - 10%)

Severe dehydration (≥10%)

Shock

General appearance

Well

Unwell

Unwell / Deteriorating

Unwell / Deteriorating

Consciousness

Alert & responsive

Restless / irritable

Lethargic / unconscious

Lethargic / unconscious

Sunken eyes

Absent

Present

Present

Present - grossly sunken eyes

Skin turgor

Normal (i.e. brisk // immediate)

Reduced (≤2 seconds)

Reduced (>2 seconds)

Reduced (>2 seconds)

Offer Fluid

Drinks normally

Drinks eagerly

Unable to drink / Drinks poorly

Unable to drink / Drinks poorly

Notes
1. Adults same as children, if they are unwell, the oral intake will be poor and drinking poorly

Reference:
1. Paediatrics Protocol 4th ED, 2018

Other parameters used for hydration assessment:
• Color of skin
• CRT
• Temperature of peripheries – warm / cold
• Pulse volume
• Pulse rate — tachycardia / normal heart rate

Any signs of shock?
• Compensated shock — CCTVR+ Tachycardia + Normal BP

• Decompensated shock — CCTVR + Tachycardia + Hypotension

References / Further Reading

  1. Day of appearance of rash in febrile patients [link]

Take Home Message

1. At ED, it’s important to determine if the child is stable and whether resuscitation is required
2. Children unlike adults, can deteriorate very fast
3. Always remember to ask regarding oral intake and diapers change frequency to evaluate hydration status

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