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:
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 |
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
- Day of appearance of rash in febrile patients [link]