1.Assessment of febrile child ages 3-36 months
2.Predicts serious infection (Occult Bacteremia)
3.Quantifies "Toxic Appearance" in children
1.Score = 10 : Incidence serious illness: 2.7%
2. Score = 11-15 Incidence serious illness: 26%
3. Score >16 Incidence serious illness: 92.3%
Quality of Cry
Strong or No cry: 1
Whimper or Sob: 3
Weak cry, Moan, or high pitched cry: 5
Reaction to parents
Brief Cry or Content: 1
Cries off and on: 3
Persistent cry: 5
Awakens quickly: 1
Difficult to awaken: 3
No arousal or falls asleep: 5
Pale, Cyanotic, or Mottled: 5
Eyes, skin, and mucus membranes moist: 1
Mouth slightly dry: 3
Mucus Membranes dry, eyes sunken: 5
Alert or Smiles: 1
Alert or brief smile: 3
No smile, anxious, or dull: 5
<3 yrs: I recommend child in mothers arm, immobilised... while one injects in thigh or butts.
3yr and above : no amount of counselling helps. Just inform that he may be given an injection which may not pain if he cooperates. Then apply restrain and finish the procedure in shortest time without the kid realising most of it.
The maximum pain occurs when the chemical brushes with cut nerve endings.
use a separate needle to inject.
and when you withdraw needle out, let it be in shortest time span ( preferably with a jerk... rather than slow removal that pains alot).
injecting medicine in... slow or fast usually doesnt much affect duration or intensity of pain...( u r in painless intermuscular or fascial plain)
avoiding bony sites and periosteal injury will be preferable. ( so prefer bulk of muscle... dont hurry to inject)
It may sound very surprising but i need to combine these contrast topics to discuss together. As many a times I come across situations where the treating docs even residents and pediatricians alike have made a common mistake of misunderstanding one as another and created problems for the patients and themselves.
How is it possible?
Shock is a situation caused by disparity between fluid volume and capillary bed manifesting as poor pulse and blood pressure.
CCF or congestive cardiac failure is a condition caused due to increased preload following venous overload or cardiac hypo function.
In late stages both these cases can overlap, as shock can cause cardiac dysfunction and cardiac dysfunction due to CCF can lead to shock.
And thus most patients coming in late stages to emergency room are falsly interpreted as shock or CCF especially when the facility for JVP CVP BP measurements is not available or faulty. ( yes its likely- as BP measurement varies with age size of cuff and the person who is taking BP and there are no clear cut levels in any area or age for lowest normal BP. Also CVP may be difficult due to venous access in shock. The CVP reading change with movements , intervention and position of CVP catheter tip which may require an X-ray to confirm.)
In addition the confusion arises due to possibility of presence of congenital heart disease or carditis in children. if the child had a chronic heart disease, its more likely that the decision fo CCF si very often made, as the baseline hepatomegaly and cardiomegaly as a part of chronic heart failure is wrongly interpreted as acute CCF.
Similarly, as in acute carditis or sepsis, raised JVP the only important clinical sign apart from cardiomegaly, is difficult to examine and interpret especially in infants, the failure of heart is interpreted as shock.
As both these conditions present with common findings at some stage
: Tachycardia, poor or weak pulse and low blood pressure and desaturation.
They are easily confused unless an expert decides from various other clinical markers.
why do we need to discriminate the two: CCF and shock?
Because, the treatment differs.
for CCF the main therapy is volume reduction diuresis and judicious blood transfusion and digoxin. And rarely inotropes.
And in shock its fluid pushes and inotropes.
A wrong judgment will take you in wrong direction with vicious events.
Some basic understandings will help not making this mistake:
read aug 2008 IJP symposium septic shock Indian journal of pediatrics
A good number of RMOs kept asking questions regarding child health issues. It wasnt only the knowledge but the skill and experience based tips were often asked for.
This site is aimed at helping medical students, allopathy and non alopathy RMOs and general practitioners in understanding and managing child health and related issues.