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CASE HISTORY
Two hours later: admitted to paediatric ward.
Nursing assessment: Temp 38.4, HR 172, RR 45, BP 112/50.
Small pin prick rash on abdomen
Ward SHO reviewed child
Sleepy but rousable, no neck stiffness or photophobia, HR 171.
No rash but he has a few old chickenpox scars.
Chest clear.
Diagnosis: viral URTI. Child sent home. Child 3 years old with short history of fever, shaking and generally unwell.
ED Triage assessment:
High temperature, he looks flushed, no rash, unwell child.
Ten minutes later– ED SHO:
Febrile child, listless, irritable and drowsy.
Temp 39.7, HR 170, RR 55.
Pyrexial and drowsy: ? cause, refer to paediatric team.
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QUESTIONS ON CASE 2
 
Q 6 of 12: Persistently abnormal signs/symptoms?
Yes  No
CORRECT
: Still tachycardic, tachypnoeic, drowsy two hours after admission. Fever has diminished after antipyretics, but child still pyrexial; taken with other signs, cannot be dismissed as a viral illness.
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Further Information
| Age
| HR/min
| RR/min
| Systolic BP
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| <1 |
110-160 |
30-40 |
70-90 |
| 1-2 |
100-150 |
25-35 |
80-95 |
| 2-5 |
95-140 |
25-30 |
80-100 |
| 5-12 |
80-120 |
20-25 |
90-110 |
| Over 12 |
60-100 |
15-20 |
100-120 |
From Advanced Paediatric Life Support—the Practical Approach. 30
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