Paediatrics - Queensland Health - Queensland Government

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Paediatric presentation Diagnostic and pathology services • Point of care testing is available in some facilities for example iSTAT® blood gases • Pathology request forms -- all pathology requests made by SM R&IP must be compliant with the specific Health Management Protocol -- if in the clinician’s opinion other pathology is required this must be ordered by a MO • Pathology results / follow up: -- if a SM R&IP has initiated pathology testing according to the Health Management Protocol they are responsible for the follow up of pathology results 552 -- MO should be consulted if results are abnormal • Refer to the Pathology Queensland Specimen Collection Manual available at: qis.health.qld.gov.au/DocumentManagement/Default.aspx?DocumentID=10021&Doc umentInstanceID=45973 Consulting the MO • If it is necessary to consult with a MO present your findings clearly and methodically • It is often easier if you write your findings down first (time permitting) • It is helpful to advise the MO early that you have a child about whom you want some advice or alternately who you think may need evacuation • Always begin with the name and age of the child, then start with the presenting concern and proceed through to the examination. Say what you think is wrong - your assessment is important; after all, you are actually with the child • Always consult with the MO if you are not sure. Discuss difficulties and problems with the MO during routine visits. Take the opportunity to discuss general or specific cases or issues with the MO at the next clinic visit • See Royal Flying Doctor Service (Queensland Section) and Queensland Emergency Medical System - consulting the MO / ISOBAR References 1. Pemsoft®. Normal vital signs. 2008-2011 [cited 2011 August]. 2. The Royal Children’s Hospital. Acute Pain Management 2010 [cited 2011 April]. 3. Estes M. and Schaefer K.P., Health assessment & physical examination. 2nd ed. 2002, Albany, NY Delmar. 4. Talley N. and O’Connor S., A systematic guide to physical diagnosis: clinical examination. 6th ed. 2010, Australia: Churchill Livingstone: Elsevier. 5. Murtagh J. and Rosenblatt J., John Murtagh’s general practice 5th ed. 2011, Australia: McGaw Hill. 6. Corrales A.Y. and Starr M., Assessment of the unwell child. Australian Family Physician, 2010. 39(5): p. 270-275. 7. Douglas G., Nicole F., and Robertson C., Macleod’s clinical examination 12th ed, ed. Douglas G., Nicole F., and Robertson C. 2009: Churchill Livingstone: Elsevier. 8. Advanced Paediatric Life Support Group, Advanced Paediatric Life Support The Practical Approach. 5th ed, ed. Samuels M. and Wieteska S. 2011: Wiley-Blackwell. Controlled copy V1.0 Primary Clinical Care Manual 2011
Child with fever Fever is usually an indicator of infection. Two or more infections may co-exist, e.g. URTI plus meningitis Babies less than 3 months of age contact MO immediately Consult MO for the child with a fever with no obvious source of infection or a fever that is persistent despite measures taken Clinical assessment performed Consult MO Yes Significant features of assessment unclear or you are unsure of cause? No Basically well child Basically well child Basically well child Basically well child Child unwell Child unwell Child unwell Child unwell Sore throat, ears, nasal discharge, cough, cervical lymphadenopathy, red inflamed throat, tonsillar enlargement No other significant features URTI type symptoms may be present Vomiting and diarrhoea Obvious abscess or cellulitis Cough Dysuria, frequency, smelly urine Rapid onset high fever May have history of URTI like illness Bulging ear drum on examination No other significant features No other significant features Rapid breathing, chest recession Positive urinalysis Stridor, drooling, unable to eat, drink or talk, reluctant to move neck Neck stiffness or bulging fontanelle No other significant features Headache, photophobia +/- Rash Paediatric presentation See URTI See Acute otitis media See Acute gastroenteritis See Bacterial skin infections See Pneumonia See UTI See Epiglottitis See Meningitis Primary Clinical Care Manual 2011 Controlled copy V 1.0 553 Tachycardia Child with fever No other significant features No other significant features
Page 1 and 2: Section 6 Paediatrics
Page 3 and 4: Paediatric presentation History and
Page 5 and 6: Paediatric presentation Presentatio
Page 7 and 8: Paediatric presentation Standard cl
Page 9: Paediatric presentation Physical ex
Page 13 and 14: Child with stridor Stridor is a har
Page 15 and 16: Any history of significant trauma?
Page 17 and 18: Meningitis Meningitis Recommend Co
Page 19 and 20: 6. Referral / consultation Consult
Page 21 and 22: Respiratory problems • For the ch
Page 23 and 24: Respiratory problems 1. May present
Page 25 and 26: Respiratory problems 4. Management
Page 27 and 28: Child < 3 months Contact MO immedia
Page 29 and 30: Immune complications Acute post st
Page 31 and 32: Immune complications Schedule 4 Ben
Page 33 and 34: Immune complications Acute rheumat
Page 35 and 36: Immune complications Australian gui
Page 37 and 38: presence of RHD Place person on Re
Page 39 and 40: Ear problems • Clean the ear usin
Page 41 and 42: Ear problems Acute otitis media (A
Page 43 and 44: Ear problems Schedule 4 Roxithromyc
Page 45 and 46: Ear problems 4. Management • Give
Page 47 and 48: See Simple analgesia back cover Ear
Page 49 and 50: Ear problems 6. Referral / consulta
Page 51 and 52: Ear problems 5. Follow up Children
Page 53 and 54: Ear problems Ear discharge in the p
Page 55 and 56: Ear problems 4. Management • Cons
Page 57 and 58: Ear problems Schedule 4 Flumethason
Page 59 and 60: Ear problems Foreign body / insect
Page 61 and 62:
Gastrointestinal problems Acute gas
Page 63 and 64:
Gastrointestinal problems 4. Manage
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Gastrointestinal problems • Bottl
Page 67 and 68:
Gastrointestinal problems Nutrition
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5. Follow up Review 1 - 2 days aft
Page 71 and 72:
Gastrointestinal problems Intestin
Page 73 and 74:
Gastrointestinal problems Schedule
Page 75 and 76:
Gastrointestinal problems 4. Manage
Page 77 and 78:
Gastrointestinal problems Intussusc
Page 79 and 80:
Gastrointestinal problems • Perfo
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Gastrointestinal problems Backgroun
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Schedule 2 Folic Acid Gastrointesti
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Urinary tract problems References 1
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Urinary tract problems ○ where no
Page 89 and 90:
Bone and joint problems 3. Clinical
Page 91 and 92:
Abuse and neglect 2. Immediate mana
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Paediatrics - Queensland Health - Queensland Government

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