decision making - week 3

what is decision making

process of making choices by identifying an issue, gathering information and assembling alternations resolutions

decision making

ask, acquire, analyze, apply, announce, assess

identifying a disease, illness or problem by examining someone or something

diagnosis

wwham

who is the patient?

what symptoms

how long for?

action taken?

medication?

paediatric warning symptoms

• peeing, pooping, eating sleeping

• loss of appetite

• 24h without wet nappy

• loss of weight

• persistent raised temperature

• breathing problems

• significant earache

• discharge from only one nostril

• temperature and sore throat

• persistent night cough

• blood loss from any orifice

• neck stiffness

• photophobia

• rash which does not blanch on pressure

red flags

weight loss

blood - vomit, urine, stool, vagina, moles. very black stool could mean bleeding higher up

chicken pox

• mainly affects children

• itchy, spotty rash

• most children will catch at some point. can occur in adults who didn’t get in childhood

• symptoms start 1-3 weeks after being infected

• contagious until all blisters have scabbed off which usually happens about five or six days after rash appeared

chicken pox advice/medication

• no specific treatment usually required

• daily bath and cut fingernails to prevent secondary info

• paracetamol

• apply calamine, virasoothe

• oral anti-histamine

• stay off school/nursery until last spot crusts over (usually 5-6 days after rash appears)

meningitis early symptoms

• pain in muscles, joints or limbs such and in legs or hands

• unusually cold hands and feet or shivering

• pale or blotchy skin and blue lips

• severe headache, fever, vomiting, feeling unwell

• fever → 38C or above, face hot, look red or flushed

meningitis later symptoms

• drowsiness, confusion, seizures or fits.

• unable to tolerate bright lights (photophobia) - less common in young children

• stiff neck - less common in young children

• rapid breathing rate

• blotchy red rash that does not fade or change colour when a glass is placed against it (rash not always present)

• picture will be in hospital OSCE

urticaria

• common in children and adults with allergies (atopic conditions)

• urticaria (hives, weals, welts or nettle rash) is a raised, itchy rash that appears on skin

• may appear on one part go body or be spread across large areas

• very itchy

• few mm to size of hand

• affected area may change in appearance with 24h, rash usually settles within a few days

causes or urticaria

• occurs when a trigger causes high levels if histamine and other chemicals messengers to be released in the skin

• these substances cause blood vessels in affected area of skin to open up ( often resulting in redness or pinkness) and become leaky. extra fluid in tissues causes swelling and itchiness

why is histamine released?

• allergic reaction - food allergy or a reaction to an insect bite or sting

• cold or heat exposure

• infection - such as a cold

• certain medications - non-steroidal anti-inflammatory drugs (NSAIDs) or antibiotics

• in many cases or urticaria, no obvious cause can be found

treating urticaria

• identify + eliminate/avoid triggers

• in most cases, treatment no needed for urticaria as rash often gets better within a few days

• antihistamines can be given to relive itchiness if causing discomfort

• short course of oral corticosteroids may occasionally be needed for more severe cases or urticaria

anaphylaxis

urticaria can be one of the first symptoms of a severe allergic reaction known as anaphylaxis

• swollen eyes, lips , tongue, hands and feet

• feeling lightheaded or faint

• narrowing of the airways, which can cause wheezing and breathing difficulties

• abdominal pain, nausea and vomiting

• collapsing and becoming unconscious

should be treated as medical emergency

slapped cheek syndrome

• viral infection particularly common in children and babies

• typically causes bright red rash on both cheeks and fever

• most babies won’t need treatment, as slapped cheek is usually a mild condition that passes in a few days

ring worn

• common fungal infection

• can appear anywhere on body, including scalp (tinea wapitis) and groin (jock itch)

• rash, red, sliver or darker that surrounding skin, depending on skin tone

can be passes through close contact with:

• infected person or animal

• infected objects - bedsheets, combs, towels

• infected soil - very rare

treated with non prescription creams such as azole group ( clotrimazole, ketoconazole etc)

can apply unto 4 weeks

baby acne (neonatal acne)

• pimples sometime appear on baby’s sheeck, nose and forehead wishing month of birth

• tends to get worse before clearing up completely after a few week for months

• washing baby’s face with water and mild moisturizer can improve appearance of skin

• avoid acne treatment

hand, foot and mouth

• common viral illness

• causes blistery rash on palms of hands and soles of feet, as wells as ulcers in mouth

• baby may also feel unwell and have fever

• treatment not usually needed as baby’s immune system clears virus and symptoms.= go away after 7-10 days

• in unsure, refer to GP

impetigo

• highly contagious

• bacterial infection of the surface layers of skin that causes sores and blisters

• usually around nose and moth but also can affect other areas of face and limbs

• avoid close contact, sharing of clothes and bedding

• not usually serious

• prescription for antibiotics (oral or topical)

• clearing in 7-10 days

• usually heals without scarring

• need antibiotics (staph/strep infection) therefore refer/prescribe antibiotics

• school: stay away until lesions have dried

• no long-term effect/complications

• rare of serious complications

measles

• rash usually spread to whole body

• rash tends to join together

• blanches on pressure

• cold symptoms

• viral infection

• red spots with white (greyish white) centre on inside of cheek (KOPLIK’s spot)

• pregnancy

KOPLIK’s

• uniques to measles, temperature, cold/conjunctivitis

• small white spots may appear inside the cheeks and on the back of the lips a few days later, these spots usually last a few days

scabies

• common infections of the skin that can affect people of all ages

• caused by tiny mites that burrow into skin

• often spread between family members

• babies develop tiny and very itchy spots all over the body, including on the soles of feet, armpit and genital area

• treatment with creams that kill the scabies mite needs to be given to the whole familyy at the same time for it to be effective

headlice

• wingless (2.5-3mm)

• brown/grey in colour

• feed on human blood

• its saliva has anticoagulant properties

• some are somewhat translucent and sometimes you can see the red colour of the aspirated blood

• not due to poor hygiene

• head-to-head contact is how it spreads

• there’s nothing you can do to prevent

• can help stop by wet or dry combing regularly to catch early

symptoms of infestation:

• itchy

• feel like something is moving in your hair

• only way to be sure if someone has head lice is by finding live lice

• can be done by fine combing

• not active infection in only nits

• nit → empty egg case

treatment:

• start ASAP

• starts treating everyone who has head lice on the same day

• children can still go to school since in theory, if child doesn’t touch anyone, it won’t spread

• lice and nits can be removed by wet combing. try this first

wet combing

• wash hair with shampoo

• apply lots of conditioner

• comb whole head, roots to ends

• 10 min → short hair

• 20-30 → long, frizzy or curly

• do wet combing days 1, 5, 9 and 13 to catch any newly hatched head lice. check that everyones hair is lice free on day 17

• if it doesn’t work use shampoo like herding (dimethicone)

• avoid permethrin, heal lice “repellent”, electric come, tree and plant oil treatment

• if no active infestation (only nits present) then no need to use shampoo, just wet combing will too

• use antihistamine for the itch

worms in humans

• thread worm (pin worm)

• tape worm

• round worm

• hook worm

most worm infection not very serious and can be treated with medicine

thread worm most common in UK

• small white worms in poo that look like thread

• extreme itching around anus, particularly at night

worms - modes of infections

• touching objects ir surfaces with worms eggs on them - someone either worms doesn’t wash hands

• touching soil or swallowing water or food with worm eggs in it

• walking barefoot on soil containing worms

• eating raw or uncooked beef, pork or freshwater fish (salmon, trout) containing baby worms

• can cats from pets but rare

worms - when to refer/see GP

• large worm or large piece of worm in poo

• red, itchy worm-shaped rash on your skin

• sickness, diarrhoea or a stomach ache for longer than 2 weeks

• unexplained weight loss

treatment:

• all worm infections treated the same

• anthelmintics such as mebendazole

• dose/duration different on type of infestation

when should child return to school?