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Rash/Derm Guide

Guide Taken from the Primary Care Dermatology Society(PCDS) other good sourse is DermnetNZ.

A relatively easy way to find out what you’re looking at!

Rash – Apearance
Rash – Site
Lesions
Skin Conditions (DermnetNZ – a bit clunckier)

Afebrile Seizure (Paed)

Child (<16) presents with PAROXSYMAL EVENT – episode of loss of consciousness, blank starring or other brief unusual behaviour

History

  • Detailed description of event
  • Before (trigger? Concurrent illness? Behaviour change? Cessation of activity?)
  • During (collapse? Colour change? Altered consciousness? Body stiff or floppy?, limb movements?)
  • After (sleepy?, unusual behaviour? Unsteady?, limb weakness?)
  • Copy and paste YAS EPR entry
  • Can child be distracted at any point
  • Does the event occur during exercise
  • Developmental history
  • Family History
  • Assess for red flags below

Examination

  • Documented neurological examination including gait – observe eye movement, look for a new squint
  • Cardiac Examination including blood pressure (esp if associated with exercise / colour change)

Investigations

  • Ask parents to video events and keep detailed, descriptive diary (day, time, event-before, during and after)
  • ECG
  • Routine bloods are NOT required unless clinically indicated

RED Flags

  • Age < 1year
  • Acute confusion
  • Pervasive behaviour change / lethargy
  • New onset, recurrent convulsive seizures (>1 per week)
  • Abnormal cardiac examination or ECG findings
  • Abnormal neurological examination findings
  • Symptoms of raised intracranial pressure (blurred / double vision, headache at night or on waking, persistent nausea / vomiting)
  • Signs of sepsis / meningitis

Referral

  • RED Flag Ref to PAU (Paeds Reg)
  • Non Urgent Referral –
    • Document history and examination (esp. neuro)
    • Ask parents to video events
    • Send message to Salim Uka and Matthew Taylor through EPR “Communicate”  to request appointment (usually within a few weeks)
  • No Referral Required –
    • The following are examples of benign paroxysmal episodes that do not require a referral to paediatrics if the diagnosis is secure:
      • Breath holding attackes
      • Simple Faint
      • Reflex Anoxic Seizures (document normal ECG)
      • Sleep Myoclonus
      • Night Terrors

ECG placement & mis-LEADing ECG’s

  • V1: 4th intercostal space (ICS), RIGHT margin of the sternum
  • V2: 4th ICS along the LEFT margin of the sternum
  • V4: 5th ICS, mid-clavicular line
  • V3: midway between V2 and V4
  • V5: 5th ICS, anterior axillary line (same level as V4)
  • V7: Left posterior axillary line, in the same horizontal plane as V6.
  • V8: Tip of the left scapula, in the same horizontal plane as V6.
  • V9: Left paraspinal region, in the same horizontal plane as V6.

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