Meningitis | Cases

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

QUESTIONS ON CASE 1

Q 9 of 9: Appropriate action taken?

Yes <incorrect

INCORRECT : no response to antipyretics, sent home without adequate assessment, examination and investigations

Further Information

It was too early in the disease process to specifically diagnose meningococcal disease while the child was in the Emergency Department. However there was sufficient cause for concern, namely an unremitting fever, a new rash, general malaise and a potential focus of infection. This child should undoubtedly have been referred to the paediatricians.

CASE HISTORY

QUESTIONS ON CASE 1

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