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Key points
• Assess the whole child, not just the rash.
• Children who are afebrile, have normal observations, look well and are well hydrated, do not usually have an emergency, whether or not they have a rash.
• Be extra cautious when assessing a child who looks unwell, has abnormal observations, has a non-blanching rash, or a fever.
General approach to rashes
As with most of paediatrics, the list list of possible symptoms can be limited, whereas the list of possible causes is extensive, due to multiple pathologies causing the same symptom.
Therefore you need to take a full history of the rash and other symptoms
• Ask whether the child has or had a fever and for how many days
• Ask about fluid intake and output and overall activity
• Vaccination history, immunodeficiency or any other chronic conditions that make a child higher risk of complications from infection
You also need to do a full physical examination.
• Don’t forget to look in the mouth/throat
• Check for petechiae (non blanching rash)
• Examine the entirety of the child’s skin including palms and soles
• Check for lymphadenopathy
By the end of this series you will:
1. Recognise common serious rashes
a. Meningococcal sepsis
b. Kawasaki disease
c. Measles
2. Know enough to escalate to a senior when you encounter other serious rashes even if you can’t remember enough to actually diagnose them.
a. Toxic shock syndrome, staphylococcal scalded skin, Stevens Johnson Syndrome, Toxic Epidermal Necrolysis
3. Recognise a few common, less serious rashes
a. Urticaria
b. Chickenpox
c. Roseola
What I haven’t included
This is not a comprehensive treatment of the topic. I have deliberately restricted the content to the most serious and most common rashes, and focused on recognition rather than management. This is for the following reasons:
1. Most people working in ED find trying to diagnose rashes overwhelming and trying to cover everything is likely to exacerbate this.
2. If you achieve the above outcomes you will be practicing safely and know when to escalate.
3. If you can recognise and diagnose the rash, you can look up the management so it is less crucial to have this information in your head.
This video is for educational use only. It is produced by doctors for doctors, pharmacists and other health professionals. Most of my videos are reviewed by multiple senior doctors for quality control prior to publication, but this still represents my personal take on this topic. This video is not medical advice.
References:
bestpractice.b...
dermnetnz.org/
dontforgettheb...
www.rch.org.au...
Негізгі бет Introduction to rashes in the paediatric emergency department.
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