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Good, Good. Good evening. Can you hear me? Yes, we can hear you, Doctor Abdeljilil. It's, uh, doctor Sharon Raymond speaking. Uh, Lyrica is also on the call, and she's moderating. I want to welcome everyone. Uh, this afternoon, this early evening to the lecture with Dr Abdeljilil, consultant, pediatrician who is going to be speaking about identifying the sick child were going to ask everyone to stay on mute. The lecture is recorded. If you have any questions or comments, please put them in the chat. About 10 minutes before the end of the lecture, we will ask for you to give your feedback. There'll be a link, Uh, and we're very much dependent on that feedback. So please be sure to click on the link and give us your feedback. And once we have all the feedback, we will post the certificate on the chat. As you can see, I've asked for people to put their name, year, study, medical school and where they're located in the world. At the moment, which country? Just to give us an idea of who is on the call with us, who's on the lecture and maybe any needs that people might have so that we can reflect on that later. Um, and without further ado, Lupica, I'm sure I must have missed something out. So, please, uh, chip in if you need to. Um, But if not, then, uh, then we will pass over to Doctor Abdul Gallon and the people who will keep an eye on the on the chat. And if there are any questions, uh, we'll present them. She will present them to Doctor Abdul. Golly. Thank you. Thank you. Sharon, Um, can you see my screen or it's not projecting. We can see your screen. Thank you. Thank you very much for your support during this session as well, so I I wouldn't be able to see the the chart, so it depends. Um, on your reading, it it should be an interactive session. And I would like to start first of all by saying that we stand in solidarity with the people in Ukraine, and this is a photo from my country. Sudan. Uh, there is an ongoing, um, protest pro democracy protest against the military coup that took place last year. But people are standing in solidarity with the Ukrainian people because justice, injustice, anywhere is injustice everywhere? Um, so if we move to speak about identifying the sick child, Um, um, can you see the Yes, um, dealing with Children. Um, people think it is tricky, but actually, being a pediatrician, it is, I think, a very systematic. Um, I would say not easy, but, uh, work that you can do if you go very organized. And you know what you are asking about? The most important thing is exposure. Not only, um, reading about Children and pediatrics and child health, but as much as you can in your placement, try to, uh, see Children examine them and get engaged, because that's an important step in developing your skills and your confidence. Um, using evidence based practice, um, gut feeling is important. If you see a lot of Children, then you can identify that this child is unwell. Uh, and that is one of the skills that actually has been now recognized among even senior clinicians. Uh, Tele health and telemedicine is now playing a major role in improving our skills and knowledge, all of us about different aspects and different topics. Uh, there is the spotting sick child website. It's a very useful website. You can register for free, and you can do different sort of modules and see different videos and different photos for skin rash. For example, um, the challenge with in pediatrics and child health that there is a wide range between 0 to 16 years old. So we have the new names and the prematurity. We have the young people. We have the adolescent, we have the preschool Children. And there can be complex health need when we talk about single complex health needs, like asthma or diabetes. Or we can have multiple complex needs if you have a child with special needs. For example, Super Body, Who has epilepsy? Who has got feeding issues depending on the peg and therefore you have to look at all the different systems, and we have oncology, chemotherapy and radiotherapy and the effect not only during childhood, but can extend beyond that into adulthood. Uh, we have to always think always about safeguarding and about mental health. Um, and eating disorder and repair itself harm. Um, and you know, you always learn the steps about how to make sure that we do a solid assessment and then refer appropriately, uh, the social environmental factors will affect Children. Um, I wouldn't say more than adults or not, but it's, you know, an important part to include when you take history and many Xs Children. And obviously, nutrition in the first few years of life is very important for the Children growth. Immunization is a very important part of the history. Uh, because, um, is it okay or there's a message. Okay, Yeah, you can carry on. It's fine. Someone just turned on captions, Okay? Immunization is important because that will determine if you have a child who's coming with the fever and has been unimmunized. And you're suspecting certain types of you know illnesses. Uh, it's important to think, as we said, about safeguarding important thing about culture and its effect on accessing health and treating the child and accepting the advice that you provide because that may be not may not be acceptable culturally communication. Remember that we are dealing with babies who may not be able to talk, But you may be dealing with a young person who you should listen to, and as well two Children and communication is not only verbal. There is a written communication that as well have to be, uh, well documented. Um, and there is a communication within the team itself we have talked about. We talked about health access, and that can be different. It can be challenging. Um, not only, um, in in in, you know, Africa, Asia. But even in the Europe and in the United States and North, you know, America. There are a lot of issues about health access. Especially when we talk about different, like primary care or secondary care or specialist or, um, the, you know, understanding how even, uh, to reach out to health professionals. Okay, um, the slides not moving. Uh, is it moving? Um, try clicking to the next one, please. No, it's not moving. Um, you see? Moving from your side. Yes. Moving now. It's moving now. Okay. So what are the common presentation in Children? If you know this presentation with you and you master them, you will see the majority of you know cases. Uh, you know, a and in emergency department or in Children Assessment unit. This common presentation of fever Children presenting with fever, Children presenting this respiratory problem with its upper or lower tract infection. Gastrointestinal presentation can be abdominal pain or gastroenteritis. Rush, um, limping child. And we have uncommon serious presentation. Accidental, an accidental injury. But these are the common presentation worldwide that you if you are well exposed and you are, you're you're you're doing a placement in the hospital or even in primary care within family doctors or GPS. You will see these conditions most of the time, so I want you in the chat to write for me. What are the red flags that you will have in mind if you are seeing a child who's fever or with breathing difficulty, or with gastroenteritis, or has got a rash or limping? What are the red flag signs that you will have in mind that make you feel okay? This is not just fever caused by a cold. This is more than that, or this limping child is not just irritable hip. There is something more than that. So give you about 60 seconds. Far anything has been written so far about allergic reaction, asthma, weight loss, seizure, red eyes, weakness. Yeah, that's all the response meningeal signs. Excellent swollen lymph nodes. Excellent, Good. So that's like signs are very important because there are common illnesses, which are benign to some extent. You can look the the family can look after their Children at home. They don't require further medical intervention or hospital admission. However, red flag science will indicate that further referral is required on further investigation. So I don't know whether you can see this flight. It is written very small, but these are some. These are not all of the red flag signs that you have to think about. So if you are dealing with a baby who's premature, you have to be concerned because they can present with severe bronculitis. For example, um, if you have seen a child who had post natal risk factor prolong ruptured membrane or maternal infection, you may think that this seven days old is presenting, actually with infection or substance, a blue baby. I think we will all agree it is a significant red flag sign. A very high temperature, whether it's reported or uh measured, especially in the under the age of three months, is very important. Um, absent femoral pulse is, uh is a concerning, uh, sign, because it will indicate that there is a critical co occupation of that water. Um, if we have headache and And there's early morning, uh, no vomiting and other symptoms of weakness. Um, we will be concerned that the cause of headaches the space occupying region Uh, if we have blood understood, it can be just basic infection. This entry, But it can be interception. Um, it can be a presentation, sometimes of cosmic protein allergy, and usually the child is not unwell. But we are talking about when it could be assigned to something which is serious. That's happening. Obviously, if we have collapsed or loss of consciousness, we will have to look into that instills. So always when we are assessing a child, we're taking the history. We have to exclude the red flag signs. Even if the family don't mention it. We have to ask about them a very important way of assessing a child if you are in any or primary care or in the Children assessment with the pediatric system. It yet it is important that you have, as we said, a system, uh, and this system will help with, you know, have you know a thorough quick assessment. So a B C. D. E approach with other is very important And now there's a lot of hospitals, uh, in the UK and also the UK that are using the score system, the pediatric early warning score and even the pop. Some, uh, triage are using different, um, as well. Score where, um, you will come to a conclusion that can help whether this tribe is unwell or unwell. So a stands for airway, uh, be for breathing. See circulation D for it can be talking like about neurology as well. Do not forget to check the blood sugar and he about exposure like a temperature and rush. Other will be ent and abdominal examination. So and looking at the child moving or gait. So by just doing this assessment, you can have a good, um, uh, feel about how sick is a child. So would you write in the chart about some, um, um you know, uh, illnesses that can affect the airway? What could you know? Think about that. Can have a compromise airway, or you have concerns about airway among, you know, in the, you know, Children and young babies. As soon as there is any contribution, we can leave that with that loudly so we can move to the other one. So, airway, we're getting asthma. Flu, pneumonia, bronchitis, pneumonia. Again. Crew. Uh, colitis. Bronchiolitis bronchiolitis. Sorry. So group is the right one because it's an upper airway. So we were talking about where we were talking about Upper Airway. So this group is a good example. Allergy, like someone earlier. Previous that can affect the airway. Foreign body inhalation can affect the airway. Uh, pneumonia. Bronchitis are lower respiratory tract infection. So they will present in be as rapid. You know, like the kidney, um, and hypoxia. And on examination, you can have with viral induced wheezing or crackles in, uh, pneumonia. What about See, when do we get concerned about C? And how do we assess? See? So please share your thoughts in the chart. So it's card is like the cardio cardiac assessment, but I would like always in see to add hydration assessment. Any thoughts? Bleeding? That's the only one I've got so far. The skin color, low BP, hypoxia, heart failure, bleeding again. Allergy. Um, Okay, So, um, in the hypoxia or the saturation is in the breathing, you know, so that we will do is fight rate, and we'll do the saturation, as I said, the things like asthma but induce with pneumonia and bronchitis. Cardiology, someone said, Bleeding that can be in a road traffic accident can be in a massive head injury or significant head injury. Um, we are looking at the heart rate. If there is a tachycardia, um, and um, or significant bradycardia capillary fulltime. Peripheral pulses and BP is important to be measured in Children. It is the last time that will be effective, but it's a It's a serious sign. If we have low BP in Children, it's important to look at the hydration status. The common presentation for Children to present, if there is an issue, will be low volume hypovolemia because of significant diarrhea or vomiting, but it can be in severe anaphylaxis. Allergic reaction. But cardiology can be as well a presentation in a baby who's presenting with congenital heart disease, and not that's not necessarily a blue baby. There we have congenital cyanotic and acyanotic, so it is important when we're assessing, um, the baby to see whether this is cardiac, usually in babies or usually in Children. We have more problems that are respiratory more than cardiac but we have to always exclude cardiac if we have, you know, and urinate. Um, that is blue, obviously. Then we are looking at how the baby is a child, you know, conscious. So we're using There can be a modified, just common scale. That is very you know, we need to remember all the details, but we can use the basic of pool, which is alert, responding to verbal stimuli, responding to pain or unresponsive, unresponsive is very clear. Where there has to be an immediate, uh, you know, like, uh, you know, intervention. Um, but even if a child is not responding to verbal stimuli, we have to be concerned that this child is not well. We have to always check the blood sugar because if we have babies and Children, the first thing they do when they are doing well, they stopped eating and maybe drinking, and therefore they can drop their blood sugar, and therefore it's important to check the blood sugar. Um, as well. It is important to assess Children if they are having a seizure, and we will come to talk about that in a different um scenario. Now, fever is a common presentation as I said, so in E checking the temperature that is above 38 is very important. But as we're checking for a rush and we have different types of rush these in Children and if you go to the website is identifying a sick child, that's important, because I don't think in this short period we can talk about all different rashes. But what we're worried about is a nonblanching rush, because that can be meningococcal sepsis. That can be, uh, you know, low platelets are TB. We know we need to know why it can be part of any sort of low platelets in the context of a malignant, uh, you know, context. But the skin marks can be bruises. Um, and that's important to know. Is it bruises because of nonaccidental injury? Um, so that's very important about the exposure examination of the child front and back and top bottom as well. That is really important. E N T. Examination is is crucial because a lot of Children present with all the artists, media and responsible artists, and it's, uh, an important examination as well as abdominal examination. Uh, for example, if we have someone has appendicitis or surgical emergency. Um, we need to make sure that we examine the child as well as checking the nappy area if it's an infant to make sure that there are no other concerns. So we have spoken about these parts and about the vital signs, which, including the heart rate, the respiratory rate, the BP, the oxygen saturation and the temperature now having all of these vital signs and having the scores, whether it's the pews or the choose, that will not replace your clinical judgment so you can have a child that has got a score that is normal. But you look at the child and you feel this child is not well. So all of these are there to support you and making a decision, but not to take away the clinical judgment that we should do as clinicians. So I would like to highlight. For those who are not aware with the national intelligence, um, of critical excellence about a nice guidelines one of the most important guidelines for Children under the age of five, which is Children presenting with figure because now people are using this for a long time, and the traffic light and become very, I would say universal in the UK, where a different level of people are using this to guide them. Whether this child with the fever is well or there are red flag signs, what should I do? Send them home or, for example, refer them to the hospital? And if you look at that later, when you go and and and find that on a line, you will see that it is looking at the child behavior interaction, skin color, presence of the rash, the history, Um, are they hydrated or they are not hydrated. So having a pattern or a pathway about assessing Children similar to that can be helpful. So we're going to start with the case studies, and I would like to people to add in the chat what are their salts? Uh, we have to remember, here we are discussing cases. So, you know, feel free to ask questions because, um, you know you can't see the child, so you know you may not have the full picture, so we have 21 days. Old boy was brought you because he's not feeding well. He has been sleeping his body temperature at home was 38. Uh, he was born at 36 weeks by normal vaginal delivery. And there was history of prolonged rupture of membrane. So what are the thoughts about this story? Are they're red flag signs? Are you concerned or not? Okay, any thoughts were getting We've only got one response so far. Losing weight. Um, Okay, so in 21 days old, we monitor the way to see whether they are gaining weight, gaining the birth weight. So that has not been a problem. Not feeding well for only 24 36 hours. Any, uh, someone asked, How long has he not been feeding? Um, total blood count. Nappies, infection, dehydration, Any complications during birth. Okay. Good question. So no complication apart from he was born early. Um, normal vaginal delivery then was sent home after two days. Um, baby was feeding. Well, um, good question about weight. Nappies know they're reduced. Wet nappies. Yes. It's important to to think about infection and substance. It's a new unit, and at the age of 28 days, it's expression. There's prolong ruptured membrane. The baby is not feeding. Well, I'm very concerned that the baby is sleeping. I'm very concerned that the body temperature is 38. So someone started by saying that they would do some investigation. That's fine. As far as we think about substance, we will. Then B protocol. And this protocol in this age group will indicate we need to look for infection everywhere. Um, in the urine and the blood. Um, we need to give antibiotics. Um, as soon as possible. We need to think about the lumbar puncture because that can be bacterial. But still, there is a concern that it can be viral. Um, anything else that anybody would like to mention or ask at this stage? Someone's asked. Is he responding? What's his, A. VP You? So it seems like as the baby is very sleepy. So it's like responding maybe two variables, stimuli, which is really, very concerning at this age group. Okay, we have an eight month old girl who presented vomiting with loose stools. There are blood in the stools. She has these episodes of screaming on and off. She looked lethargic and floppy. She had cold hands and feet and the family, we're not sure about her urine output. What are the initial thoughts and what are the red flag size. And what are people thinking at this stage? Salmonellosis. Blood and stool is a red flag fever. Yeah, for an infection. Okay, Good. Good. So the common presentation for Children with gastroenteritis, it can be like, you know, vomiting and diarrhea. Gastroenteritis. They can lead to dehydration if you have certain infection. Some people said salmonella, you can have blood. It can be just, you know, non typhi salmonella. Or it can be sometimes, if they're history of traveling a proper typhoid fever. But in this child, there was no fever. Um, it's an eight month old. There are history of episodes of screaming. She will go very pale and lethargic, and she will pass a blood in the stool. Um, can be described as jelly like blood. Any thoughts about assessing this child? So any concerns, Um, And what should we do next? Um, I've got constipation, GITC, cyclic vomiting disorder, the century this century. Uh, okay. So obviously we're concerned about this child because he has got cold hands and feet lethargic and floppy. So if you look at the airway Airways patent, be the child is, uh, maybe the technic maintaining saturation just okay, but the tachycardia and see. And there's a beautiful time, which is prolonged BP is coming towards the lower end. Um, and, uh, the child looks pale as well, responding to just being irritable, responding to her name. Um, she doesn't have any temperature. Her blood sugar is three. And, um, when you examine her, you know, there is no rush. When you go to the abdominal examination, you feel that there is a mass. So what? I'm trying to say that this can be a case of interception, but it can be a case of severe dehydration. Um, the this way, we need to provide an IV access. We need to take blood. We may need to give fluids for resuscitation. If we feel it's interception, then we have to have surgical assessment. Urgent ultrasound? Because this child may need a surgical intervention. Either that's by interventional radiology or in theater. And, um, if the child, for example, um um is have low BP, we may need to give more than just some fluid boluses any question at this stage, or should we move to the next one? Just aware of the time we have 15 months old boy who presented with fever more than 38. He has a runny nose. He has a brush. He's drinking fluids. But he's not eating. And he has a breathing difficulty. Mom just feels like he's been panting all day as well. She describe him as having a noisy breathing. So 15 months old boy with fever and breathing difficulty and noisy breathing. What are the common presentation? And how can the rush be helpful at this one response so far? Allergic rhinitis. Uh, tonsillitis? Yes, Pneumonia. Acute respiratory viral infection kills your cardia. Bacterial pneumonia. Okay, so I don't think we're thinking here about allergic rhinitis. Um uh, but we can discuss that later. We are thinking about an infection that can be viral, but that's common. The rash is a blushing market about the rash. Um, and the child has got crackles by. Naturally, the child has got high respiratory rate, but has got good saturation. So not hypoxic. Normal heart sounds normal to peripheral times of drinking fluids. Not dehydrated. So, um, there are crackers, but there are no wheezes. Sometimes there can be and one of the common presentation can be bronchiolitis. Um or it can be viral induced ways. Sometimes you can find the happy wheezers where they have a viral infection and they are wheezing and they're breathing very, very, very fast. But they're maintaining the saturation, or or it can be bronchiolitis and can be a younger age group. And the management is usually supportive with regard to feeding and hydration oxygen if they drop their stats. And and then, um, some Children may require support with high flow oxygen or even a CPAP, and some maybe very thick and require intubation. However, it's a very common presentation for bronchiolitis or viral induced fees. It can be bacterial sometimes and pneumonia, so it's very important as well to examine E N T. Because that may be just an upper respiratory tract infection and the noisy breathing. Because the child has got a group. For example, we have a three year old girl who presented with abdominal pain for two days fever for the same duration, vomiting, noble passing stool and no diarrhea. She cries when she's passing urine. UTI again uti uti I just keep getting UTI good. So we have, I guess, was three years old. We will think that it's a urine tract infection. You can have this side test with the urine dipstick. If you have a positive leukocyte and positive nitrite that will support the diagnosis. And when you examine the child the abdomen, there is no evidence of pain over. You know the flags over the you know, the kidneys. The child does not look unwell or septic. Um, the child dehydrated. So you think I will send a urine sample from microscopy and culture? I'll consider treatment, and then I'll get the urine culture to confirm that. But if this was a child who looks unwell, significant pain. Um, and the child is septic. You may think it's not just a UTI, it can be pyelonephritis, and the child may need referral because many further intervention or if you have a very young person, young child, um um, and and have a UTI. Sometimes it will be very worried, especially under the age of six months, because sometimes that can be not only UTI can be associated sometimes with infection or sepsis. So what? I'm trying to say that it's important to think about the cause. You can have UTI as a cause of fever. And sometimes it's just UTI with no com application. Or sometimes it can be serious infection with sepsis. Or it can be with pyelonephritis. So your clinical assessment is very important because this child, you may think about giving her oral antibiotics, but she's vomiting when she may not tolerate that. Um, and therefore, that can be another reason why, for example, she needs to stay. Not just because she's really unwell, but because she can't tolerate the treatment. Um, and that can be one of the factors we have. A four year old boy who has sore throat and fever, who presented fitting for the first time. Generalized tonic clonic seizure. It happened, uh, for, um When? When? When? When the family noticed that it has been ongoing for about 5 to 6 minutes. They called the ambulance. The ambulance arrived. He stopped fitting after 34 minutes of total 10 minutes. They brought him to the hospital. He is sleeping. Um, uh, So what is the approach and what are the thoughts? And, um, what is the differential? So we've got bronchitis, pneumonia, infection. So the drug was fitting? Yeah. Viral infection, meningitis, acute bronchitis. Okay, so We have a sore throat at the moment, so it's an upper respiratory. But it's important to exclude lower respiratory tract infection. So the chest was clear. We have a fitting child. Someone said meningitis. So exclude meningitis because it can present, um, as a fever and seizure. Anything else that we're thinking about at this age group is a healthy child. Otherwise no previous. And this is normal development. Who had this sore throat and fever for? About, um, less than 24 hours. There are There's no skin rash that you can see. Um, and yes, the fitting was all bloody, uh, generalized tonic clonic for 10 minutes. Uh, someone said three. About two people have said febrile seizures, and one person has had rheumatic fever. So for Brian Seizure, Yes, Rheumatic fever. If you want to think about it as presenting as fitting, that's going to be very complicated. But, uh, febrile seizure is one of the differential. So we thought about meningitis. Fibril convulsion. Um, that's, uh, one of the common presentation. And then we have to look at other causes of fitting in the child who have sore throat and fever. Whether the child was feeding Well, was drinking where they something, you know, more complex than that. But this child, after an hour, I woke up. He was completely okay. He had a red throat. Um and, you know, I was able to go home. There was a family history of fibroids. Compulsion. That's important. Um, and, you know, advice was given about safety net about fluid intake and about treating fever. So, um, this is one of the common presentation. But as we said, we have to exclude the serious one, which is the meningitis or substance. So if we go to the next one, I don't know whether you can see that or not. Can you see it? Yeah, we can. 70 years old. Girl, family meal outdoors. They went for a picnic. Um, she had something to eat. She was complaining of funny throat swelling of her ears. Rush vomited immediately, then developed a cough. What are your thoughts? You can ask me more questions if you want me to clarify any of the points that will help you. So the family just, um they were worried. Um, so they just jumped in the car and drove to the nearest accident. and emergency department. So people of put allergy dermatitis, media, food, allergy, allergic reaction, anaphylactic reaction, scarlet fever, allergy to food. Someone's asking. What? It's body throat. Yeah. So Yeah, Anything else? So it's something which is sudden. So this child was Well, there was no fever. They went for a picnic, which means that, you know, she was okay. They didn't have concerns. Uh, they had some sandwiches. Um, and, you know, she had, you know, in that sandwich, for example, being at butter, she never had been at the bottom. The she didn't was not aware or she had sesame because there are involved enough with allergies. And, uh, she developed this Southern persistent cough, uh, feeling of something stuck in her throat. Um, immediate vomiting, um, and developed hives. So there are features here that we're worrying because it's not just mild to moderate allergic reaction. As soon as you, you know, develop features related to airway and breathing, we will label that as a severe allergic reaction, which is anaphylaxis. So how would we they manage that in in in in any If we look at the approach of a B, C d e. Um, and we have a child with allergies. We have mentioned some of these features, but let's just try to apply a B C d e So a We have mentioned that that can be an airway compromise. And there can be a strider because the, you know, angioedema, uh, be it would be maybe breathing difficulty and widespread disease because of bronchospasm for the following biologic reaction and maybe hypoxic. See, maybe tachycardic worrying about low BP and a prolonged ruptured membrane. Uh uh, prolonged capillary full time. And we are worried if there is hypertension at this, uh, stage D, she may be alert, or she may be responding to variable stimuli. Would be very concerned if she's only responding to pain or she's unresponsive. Um, blood glucose. Would it be a major issue but has to be checked. And, um, obviously, at this stage, she should have had I am adrenaline by the but there was no ambulance, but that can be given or IV. Um, adrenaline IV fluids, um, as well. Um, And then, uh, there will be the antihistamine and, um, the salbutamol uh, nebulizer. There are new guys lines for the treatment of allergy in the UK um, compare it to your local if you are practicing outside. But the main way for treatment is adrenaline, adrenaline and IV fluids. Salbutamol, uh, then hydrocortisone and antihistamine. So there has been a few changes. Is what I spend more time on this slide. 10 years old boy who presented with vomiting, diarrhea and again blood reduced urine output as skin rash. And this drug was really unwell. We had mentioned some, uh, dehydration. Good. A chronic diarrhea. So it's an acute diarrhea. It's not chronic good thoughts. It's not inflammatory. Bowel disease can be a presentation. Pancreatitis shocked due to infection. Mhm. So this is a child who has not been, um, traveling, But they went to a farm. Okay. And then, you know, two days later he had this vomiting. There's no bile. He has diarrhea. And he has blood. Um, on this was seen and was given advice about diet real light, but three or four days down, um, line. He's more and, well, he looks pale. He has reduced urine output. He has got a particular all over his body. So what am I trying to give him? Two, uh, trying to give him two a sick child with diarrhea and blood. Um, they checked the BP. His BP was actually high. He was hypertensive. Any thoughts about what could be the differential diagnosis? Actually, at the moment we have a child with this, uh, problem in our awards has, you know, and actually in, in, in the pediatric intensive care now. So someone has said enteric fever nephritis. The century. Yeah. So this trial has got a problem which is called humility economic syndrome. Um, which at us when you have an infection with certain bacteria different. But the the common one is equal. I 0157. And in this case, um, you trying to say that he has particular? Because there is a low platelet count, but as well there is, issue will be pale. Um, there will be renal impairment, and he's hypertensive. So, um, in this case, these Children can be very sick. They may need blood transfusion. They may need renal dialysis, admission to the intensive care. And, um, the history of going to the farm is related to having, you know, exposure to equal. I, um some people may think about salmonella. Uh, it depends where we're talking about this child. As I said, they're salmonella that are Type I and another one on TV. So, um, taking a good history and history about traveling and his dramatic exposure, but as well assessing the child who is really sick. The problem is sometimes these Children, because they have gastroenteritis, it's put down to survival. Gastroenteritis just continue with diet real light. And then we have to assess the child. Clinically. We have to make sure that the child is not deteriorated and giving good advice and safety net for the child come back can come back. The family can come back if the child is not improving. 14 years old girl who presented to the GP or the family doctor. Very lethargic, thirsty, vomiting and the family have noted lots of weight recently. Diabetes yet diabetes again. Okay, very good votes. Um, so this can be a presentation or the first presentation of diabetes? Um, insulin dependent. And it's important to assess, um, Children and to check the blood sugar and the blood key tone and send them for specialist assessment. First presentation because different reasons. First of all, this child is possibly in DKA diabetic ketoacidosis. And the treatment is really has to be, you know, with the pediatric team, because we don't want the child to develop complications, but as well. It's an important opportunity for teaching and training. Um, the use of insulin and the tired and supporting the young person and the family, which can be challenging. Obviously, uh, if you have such a long term complex, um, illness, uh, this child can can thirsty, I think, is the key here, But it can be. There can be some questions about whether this child has bloody diarrhea. Like someone earlier said, If it's like inflammatory about, um, disease, chronic ulcerative colitis. And this is the first presentation, I think being very thirsty and passing a lot of, uh, a large amount of urine indicating, uh, high level of blood glucose. So 16 years old boy who has a background of lymphoma, Um, and on treatment as a central line he presented with fever. What is the approach and what are the red flag science? Hodgkin's lymphoma Fever is a red flag. Yeah, so we know he has got lymphoma, so it has been diagnosed and you know, But he and he's on treatment. But the family called, saying that he has developed fever and he had, you know, a recent chemotherapy treatment. So, um, what I'm trying to say if we have a child has got a background of an oncology has got a central line. It develops fever. You maybe need to panic. We have to be careful with neutropenic. Fibril illness is there are certain protocols. We have to be worried about central line infection and therefore the, you know, investigation about taking central align cultures and referral cultures. Checking the neutrophil count, Um uh, covering with broad spectrum antibiotics. And so, this child, you can say, Oh, you know, it can be just an upper respect tract infection. Have just antibiotics orderly without having a full thorough assessment and investigation and then, you know, coming to a conclusion like, you know, we have excluded or not. Usually they will have a first line of treatment and then stop antibiotics if the culture is a negative. Unless, uh, the child you know, the senior assessment indicate that the child you know has got a tonsillitis and they're happy, which is rare, not common, because usually people will take the line. So what I'm trying to say if you have a child like this with Central line with potential, need to be neutropenic fever. If you are in primary care, you are in any don't make the decision. It's important to get in touch with their team and with the pediatric team to assess the child and make the decisions accordingly. And And this is a website, I think, where there are some assessment about Children or sick, you know, sick Children. But I think the time limit, if there are any questions, hopefully I didn't take all the time. So, as you can see in this, um, sort of, uh, 45 minutes or more, maybe we went from 21 days old to 16 years old. Boy, it's a wide range, but the approach should be systematic. And as far as you have good exposure, uh, you will be able to identify the common presentation of Children when they are sick, or you feel that it's a common illness and you are not worried about the child. Thank you, Doctor. You're welcome. Thank you very much. Is there anyone who would like to ask any questions? if anyone has any questions, please pop them in the chat so that people are not talking at the same time, if possible, or any comments. So someone someone is asking what is Hodgkin's lymphoma? So this is one of the types of lymphoma that you know can present sometimes with the large lymph nodes. But this is, I think, outside the limit of this presentation. Yeah, uh, someone else would like to know. What is the central line that came up in the last case study? Yeah. Good question. So central line is an IV access for Children who have got long, um, complex illnesses requiring, um, for example, chemotherapy. Sometimes it can be used in pediatric intensive care for Children who are requiring support, like no trips. Um, uh, And it is usually in one of the big veins, and therefore there is a risk of developing infection or substance because it's a foreign body inside a big vein, and therefore it can lead to, uh, substance or infection. You are expected you are giving medication. You have to do it aseptic technique so that there is no risk of infection. Uh, someone is asking if you can send the link for the pediatric cases. Uh, in the in the presentation. This presentation? Yeah. Are you happy for students to receive the presentation? Yes, Sharon, if Sharon feels that's appropriate the oh, okay. Someone is asking. Please explain to an osteoporosis in test. Yeah. So inception is one of the surgical, um, sort of, uh, emergencies where we have part of the intestine folding into each other and so, uh, compromising the blood supply. So part of the intestine may become ischemic. And if we don't save the child, obviously there would be a lot of complications. Um, what causes the, uh, part of the story of the slide on the other is not clear whether it's an enlarged lymph nodes or, um, other causes. The presentation will be with, you know, child is unwell. May have loose stools. Um, significant screaming episode. Pulling up the legs with pain, going pale and having bleeding, which is a jelly, like so this is one of the presentation where if you see one child, you will never forget it. Um, and obviously it doesn't mean that every child who's presenting with abdominal pain and screaming or bleeding or, you know, blood, mucus blood, uh, in the stool because of gastroenteritis have gotten perception. But any junior colleague who's not sure, uh, it's better to get some advice from someone senior to assess these Children. The usually corrected can be by, um, you know, interventional radiology. And it's just, you know, it's not like before. Usually used to go to theater, but sometimes still a surgical, you know, correction can be required. Um, someone is asking Is funny throat the same as a sore throat? Is what is funny throat the same as a sore throat? Uh, this is a description that some people may give you, and they may indicate, you know, it's painful, but I think what we're trying to say in energy that suddenly this child had this sort of feeling of something stuck in their throat, and so it can be in description. Sore throat is pain and can go with more with infection. But it's about how the patient, so sometimes in a clinic it's it's one of the you know, the Children said, Oh, and I was eating this, and then I had this funny feeling in my throat. I asked what you mean by funny feeling, and some of them say it's itchy. Others say it's like something's stuck in my throat. Thank you. Um, what signs should one pay pay attention to in the case of bacterial gastroenteritis, So gastroenteritis, usually in Children, um, is limiting and, you know Children were recovering from it. It's usually viral, even bacterial gastroenteritis. We don't do anything about from giving fluids and assessing the child. And if there's fever, there are certain types of bacterial gastroenteritis that we treat for. One of them is typhoid fever because of the risk of sepsis and high mortality. So if we have gastroenteritis, I would look at it as a wider picture. I will assess the child. Am I concerned about the child from hydration point of view? I am I worried about the child from a septic point of view. I am I worried about the child that there is other complications, like we mentioned it at us. The common presentation. Usually the child will recover hydration. Management of fever, but have a safety net is for the family what to look for, when to come back or from the beginning, you have concern that this drug is hydrated, then you treat them. We rarely give antibiotics apart from like typhoid, as I said or specific, you know, bacterial gastroenteritis. So usually the treatment is hydration and fever control. All right, Thank you. Um, someone has asked what is the cause of childhood cancer? Okay, that's a big lecture. Sharon, are you having oncology? Because there's a lot of just ask this question about hearts, cancer, lymphoma and oncology. I don't think anybody can say What is the cause of, you know, cancer, unfortunately, but it can be a multifactorial. I think there might be some on oncology sessions in the future. I'm not currently sure, but we'll look into that. Uh, I can go into the next question. Um, someone has asked. Treatment of interception should include a random a first or immediately surgery. This is a clinical decision by the surgical team. Usually, people go to, uh, more um uh, said interventional radiology. Rarely to surgery, but it can be surgery immediately if the child is annual. But that's a surgical pediatric surgical assessment. Okay. Thank you. Uh, two more questions. What signs of croup Conductor here during the consultation sign of group. Yeah. So group is not by Saltation group is an upper airway obstruction because of a viral infection. Usually, uh, can we are where we reached out because we look at the child we think has group. But the presentation is strider, which is, um, uh, noisy breathing when the child is inspiring. So it's taking a deep breath, and the airway is very narrow. There are some places where immunization is not covered. You can have haemophilus influenzae. This is a serious obviously. Infection is different from a viral group. And rarely you can have bacterial tracheitis, which is really, you know, worrying because the child will be accepted. So when we talk about, uh, upper airway obstruction, we're talking about Strider that you can hear. You don't need a stethoscope. I will refer you to the website. Um uh, identifying the sick child to look to listen for a strider, which is an inspiratory noise. Thank you. And finally, what is the best way to treat Purell and tonsillitis and a child? So if we're talking about bacterial, uh, tonsillitis, Um and there is no other complication fever. Uh, you know, pain passed some, um, practitioner will still take a swap but the common is doctor local. And I will check that the child doesn't have allergies to, uh, penicillin treat as your protocol or your guidelines. Give some local energy zero. That's the flam or ibuprofen. Paracetamol, uh, fluid intake. And, um, obviously, sometimes it can be very, uh, you know, complications like Parkinson's or abscess and things which are not common. Um, and that should help, obviously. And yeah, uh, that's the standard treatment. Um, anything else? That's the final question. Thank you so much for today. No, I hope that was useful. And, yeah, I'm happy to be contacted. I'd like to do it very quick, obviously. Um, but hopefully, um, any other questions were happy to answer. Thank you. Uh, we're going to now, uh, post The certificate should be there now. Hello? Yeah, certificate. Okay, lovely. Lovely. Thank you so much, Doctor Abdul. Golly, it's been really wonderful. Such an excellent lecture. And to repeat for moderating so brilliantly and for all the students that have joined. Thank you, everyone for your time. Thank you. Thank you. Thank you. Thank you. Thank you so much. And all the lovely feedback as well. We'll share that soon