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THE CHILD WITH A SKIN RASH key points for approach

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 okay don’t know. Ill children are ‘not okay’. Parents:

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THE CHILD WITH A SKIN RASH key points for approach

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  1. THE CHILD WITH A SKIN RASHkey points for approach dr Gerlant van Berlaer Pediatric section of the Department of Emergency and Disaster Medicine UZ Brussel

  2. Quiz • Only 3 possible answers • not okay • okay • don’t know het kind met vlekjes

  3. 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

  4. 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

  5. Not okay criteria II behaviour: crying: continuously, not able to comfort weak, grinding Consciousness: apathic, lethargic, somnolent ‘beware of the quiet baby’

  6. 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!

  7. Flowchart questions in case of rash 7 • Sick? • Vesicles? (hairy scalp, palms & soles, age, mouth, intake) • Bullae? (mechanical, burns) • Skin spots? • Colour? Congenital? • Coherent history with lesions? Child abuse? • Travels? Pruritus? Skin dihescence? • Petechiae? Localisation? • Vaccinations? Contaminated? Recently ill? • Associated symptoms? Drug use? titel 14-8-2014

  8. ‘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

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