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!
Author: embeds
Protected: CRH Resus 1
Rash/Derm Guide
Rash – Apearance
- Hypopigmentation (white or lighter coloured areas of skin)
- Hyperpigmentation (darker coloured areas of skin)
- Shape of lesion or rash
- Scaly / rough / peeling / crusty
- Patches / plaques (patch = larger flat area of skin change / plaque = an elevated patch)
- Macules / papules (macule = small flat lesion / papule = small raised lesion)
- Nodules (a larger raised lesion)
- Pustules (small pus-filled lesions) and boils
- Vesicles / blisters (bullae)
- Ulceration / necrosis
- Vascular
- Structural changes (firm or weak patches, or altered elasticity)
Rash – Site
- Erythroderma (a rash that covers 90% or more of the skin surface)
- Scalp and hair (hair loss or excess hair)
- Face and neck
- Eyelids
- Nose
- Mouth
- Lips
- Ears
- Neck / upper chest
- Trunk (chest, abdomen and back)
- Flexures (body folds eg armpits, groins and under breasts)
- Limbs – arms and legs
- Hands
- Feet
- Nails
- Genital
Lesions
Brown/Black/Blue
Red/Pink/Purple/Skin Colour
- Flat, and smooth to touch
- Scaly / crusty (usually rough to touch)
- Raised, and soft or wobbly to touch – either sessile (broad-based) or pedunculated (on a stalk)
- Raised, smooth and firm to touch, skin-coloured
- Raised, smooth and firm to touch, pink-red or purple
- Subcutaneous / deep seated (much of the lesion sits under the skin surface)
White
Yellow
Orange
Skin Conditions (DermnetNZ – a bit clunckier)
- Dermatopathology index
- Acne and other follicular disorders
- Blistering skin conditions
- Deep skin disorders
- Differential diagnosis of itchy skin
- Disorders of sweating and sweat
- Eczema, dermatitis and allergies
- Erosions and ulcers
- Immunological disorders
- Lesions, tumours and cancers
- Pigmentation problems
- Pustular skin conditions
- Reactions to external agents
- Scaly skin conditions
- Skin of colour
- Skin signs and systemic disease
- The mind and the skin
- Tropical skin diseases
- Vascular skin problems
Acute Behavioural Disturbance / Excited Delirium
Most of us will have seen patients like this – agitated, aggressive and often with police or security pinning them down.
- High risk of Cardiovascular Collapse/Death – likely due to adrenaline surge, heat exhaustion and injury. It can happen very suddenly.
- Keep physical restraint to a minimum – Don’t allow patient to forced face down, it’s the most likely way of killing them.
- Sedation – if you’re restraining you will almost certainly need to sedate. IV is best but if access is too risky IM will have to do.
- Aggressive management of underlying issues – esp. hyperthermia and acidosis and look out for rhabdomyolysis and DIC
Refusing treatment = Mental Capacity Assessment [LINK]
| Drug | Route | Typical Dose (mg) | Onset (min) | Duration (min) | Warning |
|---|---|---|---|---|---|
| Midazolam | IV | 2-5 | 1-5 | 30-60 | Respiratory depression, IM unpredictable onset |
| IM | 5 | 10-15 | 120-360 | ||
| Lorazepam | IV | 2-4 | 2-5 | 60-120 | |
| IM | 4 | 15-30 | 60-120 | ||
| Haloperidol | IV | 5-10 | 10 | 180-360 | Arrhythmia Risk: Only if previously used OR ECG |
| IM | 10-20 | 15-30 | 180-360 | ||
| Ketamine | IV | 1-2mg/kg | 1 | 20-30 | Theoretical risk of worsening cardiovascular instability |
| IM | 2-4mg/kg | 3-5 | 60-90 |
PDF:abd
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
- The following are examples of benign paroxysmal episodes that do not require a referral to paediatrics if the diagnosis is secure:
Myocardial Infarction (MI) – PPCI/Thrombolysis
PPCI (Leeds PPCI Pathway)
- Target: Door to balloon 90min
- Criteria:
- Time: Chest pain within 12hrs (or worsened within 12hrs)
- ECG: ST elevation MI (1mm Limb or 2mm Chest leads) OR New LBBB. (Posterior MI do posterior leads and discuss with LGI)
- Actions:
- Resuscitate
- Contact PPCI team @ LGI (Mobile No. up in Resus)
- Arrange blue light (P1) ambulance to LGI
- Prasagrel 60mg if no previous CVA or Ticagrelor 180mg if previous CVA and Aspirin 300mg (if anti-coagulated Discuss with PCI team)
- Problems:
- Intubated patient: Often LGI would accept but need to arrange Cardiac ICU. If no bed patient could go for PCI to return locally immediately after PCI to our ICU’S?
- LGI Full: Occasionally the cath lab is full and can’t accept your patient
- Calling Manchester and Sheffield: It’s worth a go but they don’t have agreements with us so having your patient accepted can be difficult
- Don’t Forget Thrombolyisis: We need to open up the patients artery, if there is no quick decision to go for PPCI – Consider Thrombolysis
Tick-Bourne Diseases
The prevalence of diseases transmitted by tick bite have increased in recent years, within the UK. And it is now recognised that there are 3 main infections
- Lyme Disease
- Tick-Bourne Encephalitis
- Babesia
Sepsis – Teaching
A quick but more in-depth than just red-flags and buffalo, sepsis teaching. Covering the pathophysiology and treatment of sepsis
we will follow it up with a teams teaching on: Wednesday August 5th 2020
Protected: CRH Safety Checklist
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.
