Rashes are really common in the Paediatric ED and the diagnosis is usually made by pattern recognition:

• well child + well demarcated lesions with golden crusting = impetigo 
• sick child + extensive non-blanching rash = meningococcal sepsis

Where can we look when we aren't sure, don't recognise the pattern or want to learn more? 

In complex PTSD (Post Traumatic Stress Disorder), anxiety is a predominant theme

At times it can be challenging to deliver good discharge advice and ensure parental understanding.  In the kid who presents with anaphylaxis it is vital that we get it right.

Eczema in kids is really common, particularly in infants under the age of 2 where the prevalence can be as high as 20% (ASCIA 2019).  These children may present to ED at the first appearance of the rash, with an acute flare or with a superimposed infection.

We know how to spot hypotension in children but what about hypertension?

Perhaps you have heard of the red-light; green-light analogy when it comes to things that occupy your time.  I remember the first time I came across this concept.  Again, I credit the psychologist, Meryem Brown, for enlightening me.  Let me explain, as I found this concept really helpful in managing my stress and energy levels.  ​

How long does a child with a streptococcal throat infection or impetigo need to be excluded from school/day care?
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This great poster from Queensland Health contains the exclusion criteria for the most common infections we see in children.

This video from the 'Be Sweet to Babies' research team at CHEO in Ottawa, Canada, demonstrates 3 techniques that have been shown to be effective in reducing procedural pain in infants.
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A 4year old boy presents after choking on a piece of apple. His mum reports that he was eating a slice of apple when he started to cough and struggle to catch his breath. She reports that there was a significant improvement within a minute but that he continues to cough and wheeze since the event. She denies apnoea, colour change or loss of consciousness.

It’s 2am, the evening team are long gone and the department is just starting to look under control. A new patient appears, Sam is 6weeks old and presents with his exhausted parents, their chief complaint is that he ‘just won’t stop crying’.

Please see the attached QCH guideline for constipation – the main thing I have noticed working in paeds ED is that often children don’t receive high enough doses of laxatives, and they aren’t continued for long enough.

Have you come across the work of Emergency Physician colleague, Dr Shahina Braganza?

This website is a repository of normal paediatric bone X-rays from birth to 15years. It is a great resource for when you are looking at a hand X-ray of an infant thinking 'Is this normal? Where are all the bones?!' ​ Check it out here

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​With the current state of Australia burning, I have been reflecting on the impact this will have on the mental health of our friends, colleagues and fellow countrymen and women.  There are moments when watching the media coverage alone is overwhelming from my safe, non-threatened living room; how unimaginable it must be for those experiencing the fires firsthand, with loss of lives, livelihood, homes and precious life memories.  

Merry Christmas everyone, and a great big thank you to everyone working over the festive period (I'm sure that's probably most of you!). 
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A little pre-Christmas pearl, a link to a paper demonstrating how dedicated paediatric EDs help improve patient waiting times and disposition.  
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It’s almost Christmas and I cannot think of a better time to share one of my favourite studies.
From the team at Don’t Forget The Bubbles - Don’t Forget the Lego. Check it out here