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.
QUESTIONS ON CASE 2
Q 7 of 12: Signs of septic shock?
Yes No
CORRECT : Yes: tachycardia, tachypnoea new rash, drowsiness, fever, rigors on presentation.
Septicaemia will lead to shock and multiorgan failure. Shock is a clinical diagnosis. The signs are a result of circulatory failure. The underlying pathophysiology of septicaemia and the capillary leak syndrome leading to these signs are briefly summarised in the pathophysiology section.
A child in early shock may still be alert and have a normal blood pressure. Child lucid despite advancing septicaemia
The early signs of shock include:
Tachycardia
Cool peripheries (CRT>4 seconds) or toe-core temperature gap of >3 degrees
Pallor, mottling
Decreased urine output (<1ml/kg/hr)
Tachypnoea – secondary to acidosis and hypoxia
(In patients with meningococcal disease, signs of shock will usually co-exist with symptoms of septicaemia.)
As shock progresses further signs develop:
Metabolic acidosis with base deficit worse than -5
Hypoxia: PaO2 <10kPa in air or saturation < 95% in air
Increasing tachypnoea, tachycardia and gallop rhythm
