Cerebral oedema is the most feared complication in children presenting with Diabetic Ketoacidosis (DKA). It occurs in about 1% of cases but has a mortality rate of up to 90% (Waldorf J et al Diabetes Care 2006; 29:1150-9). Patients will have a decreased conscious state and may also have cranial nerve palsies, headache and/or bradycardia…
How can you have an afebrile febrile convulsion? Well, it turns out you can. It occurs as convulsions in children with an acute infective illness and no fever. Usually the illness is a gastroenteritis. It denotes a more benign form of convulsion, similar to a classic febrile convulsion. A febrile convulsion is defined as a…
A 2 year old girl is brought into the Emergency Department by her parents. She has recently had some coryzal symptoms. Today when the child was picked up from kindergarten, the parents noticed a lump on the left side of the neck. It had not been there the morning before. The child is febrile at…
This is a great new study to read. The New England Journal of Medicine Study June 30 2011 – ‘Mortality after Fluid Bolus in African Children with Severe Infection’. Does this challenge what we know about fluid resuscitation in children? I remember doing an APLS sourse and challenging some of the guidelines. Now, don’t get me…
“More is missed by not looking than by not knowing” William Osler One of the biggest challenges I find, is being presented with the crying infant. The challenge is there because they are too young to tell us what is wrong. It is up to us to use all the tools in our possession to discover…
Case Scenario:A family bring their 8 month old to the Emergency Department. The child has had a recent respiratory infection with episodes of coughing. Tonight whilst being held, the mother states that the child stopped breathing and went blue and limp, then soon after, made a strange breathing noise and started breathing again. Do any parts of this story concern…
An 8 month girl is brought to the Emergency Department by her parents. She has not been eating as much as usual over the previous 24 hours and has now decreased her fluid intake. She has had a fever of 38 and they are very concerned about this rash she has over her legs. It…
Ever worried about the sick child? I know I do constantly. I particularly worry about not missing things in the very young ie., the less than 6 month olds. When I see those children in resus, I still get the butterflies. So how could I make this easier for me and you? I’ve come up…
This is a 4 minute video lecture on Kawasaki Disease. It looks at the diagnostic criteria as well as the treatment with Ig. This is also known as Mucocutaneous lymph node syndrome. It is a vasculits of the medium sized arteries and is a leading cause of cardiac disease in children in the Western world….
A mother brings her 2 year old into the emergency department. “I’ve lost my house key and can’t get into the house. Johnny was playing with it. I wonder if there is any way he could have swallowed it?” Any comments on how to manage? Pretty much leave well enough alone. If the child is…
Case Study: Paediatrics—————————————————————–A 5 month old male baby was brought into the Emergency Department by his mother. He is lethargic and limp with occasional aggravated-type crying. The conscious state is alternating between being asleep and agitated crying. He was not quite himself yesterday according to the family. Today he went off food three hours ago, quite…
This is a 14 minute audio taken from January ‘Medical Talk’. To find out more on ‘Medical Talk’, look through the ‘Products’ section. The febrile child is a common presentation in the emergency department. Fever including febrile convulsions is something we see almost on a day to day basis. We need to have an approach…
