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CASE HISTORY


2 hours later - ED doctor's assessment:
Presenting complaint: right hand swollen and painful, hand painful for 4 hours, no history of trauma.
Has been in contact with chickenpox 5 days ago.

On examination: temp 40.1 (55 minutes after Calpol and Brufen).
Small blanching spots on body.
ENT / ABDO clear.
No photophobia.
Diagnosis: probable early chicken pox. Child sent home with anti-pyretics.
Child of 5 years attends Emergency Department with sudden onset fever and painful right hand.

ED Triage assessment:
1)? Injury soft tissue
2) unwell, pyrexia. Sudden onset pain in right hand. No history of trauma, she is reluctant to have it touched. She is also generally unwell. Spots erupting on arm and back. Last had Calpol 2.5 hours ago.

Observation taken: temp 39.9

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QUESTIONS ON CASE 1


     Q 8 of 9: Reasonable diagnosis?

YesNo <correct

CORRECT : chickenpox incubation period to 10-21 days
Further Information

Other rashes.

If you diagnose a child as having another illness characterised by a rash, make sure that your diagnosis is likely or even possible.


You may be sure of your diagnosis, but if you decide the child is well enough to be sent home, remember to advise parents to return if their child becomes more unwell, even if this is only shortly after being seen.


Does your diagnosis make sense?


Assessing febrile children and trying to decide what is wrong with them is one of the most difficult tasks in paediatrics

It takes time to take a good history and examine a child properly. Before you discharge the patient from your care make sure that what you have done makes sense and that you can explain your actions and decisions to anyone who may ask.


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