Download Het kind met vlekjes

THE CHILD WITH A SKIN RASH
key points for approach
dr Gerlant van Berlaer
Pediatric section of the Department of Emergency and
Disaster Medicine UZ Brussel
Quiz

Only 3 possible answers
not okay
2) okay
3) don’t know
1)
2
het kind met vlekjes
23-5-2017
Ill children are ‘not okay’

Parents:
 More worried than usual: “this is not my child” or
“my child is different than otherwise when sick”

Signals of:
 serious bacterial infection
 Meningitis
 Dehydratation
Not okay criteria I



age < 3 months
fever >3 days, ‘high’
fluid balance:
 less drinking
 dry diapers
 vomiting /diarrhea

general physical examination:
 fast, weak pulse
 tachypnea
Not okay criteria II
behaviour:
 crying:
 continuously, not able to comfort
 weak, grinding

Consciousness:
 apathic, lethargic, somnolent

‘beware of the quiet baby’
Not okay criteria III


Neurological:
 Meningeal irritability (‘diaper pain’!)
 Convulsions  typical hyperthermic convulsions
Skin:
 colour: pale, spotted, grey, cyanotic, marbled
 Skin rash:


May be transient
petechiae [under nipples, extremities, pressured spots]
blanket away, clothes off, diaper open!
Flowchart questions in case of rash




Sick?
Vesicles? (hairy scalp, palms & soles, age, mouth, intake)
Bullae? (mechanical, burns)
Skin spots?






7
titel
Colour? Congenital?
Coherent history with lesions? Child abuse?
Travels? Pruritus? Skin dihescence?
Petechiae? Localisation?
Vaccinations? Contaminated? Recently ill?
Associated symptoms? Drug use?
23-5-2017
‘never okay’





Worried parents, incoherent parents
Very young child < 4 months
Quiet child
Extreme pallor, greyness, cyanosis, purpura
Signals of:





serious bacterial infection
meningitis, lethargy
dehydration
fast, weak pulse
tachypnea