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Okay. Um, so we're delighted to have doctor t here. Um, who will be presenting this's provision tutorial tonight? Um, as a third year. Pre medical students. Preclinical students. Sorry, I am definitely not qualified to teach any of this. However, with the help of doctor T, I think, um, you should, um, be able to find this tutorial tonight. Quite, um, useful. So I'm just a little start. Um, a little bit of a welcome from the E. V s or the Advair University Pediatric society were a society for students interested in all things pediatrics. So throughout the year, we run quite too tight. Busy schedule hosting many talks to toe realize like this one tonight. So shells and different fundraising events to raise money for the Opportunities Hospital Charity on diffuse stand. The cure, Coach, not below. But on the right hand side, you'll be able to find our membership on different perks to purchase for 3 lbs. Um, some of the upcoming events we have for the rest of the semester include our exciting of you, Kiesa, um, and in collaboration with Teddy bear hospital chart occasionally, um, on. But that's coming up in the 21st of April on, but we also have our total Siris, which is ongoing. If you would like to learn anything about deitrich career building, this Siris might be for you, Um, and next and also a final weapon. I will be on the 20th of April, and it will be focusing on the leadership in management part off the ST One portfolio applications on but the bottom Here we just have some of our social media. It's if you'd like to hear more about our upcoming events on anything that we're doing. Andre. The UPS primarily graze bruises, funds and support of Edinburgh Children's Hospital Charity and which aims to transform the lives of Children to complementing the work off the Rh. See what he as well as many other child child health care seconds a cost got men's and they're involved in many initiatives. Such a Z, um, arts and crafts activities for hospitalist Children, fundings, brushes, medical equipment on do, also supporting the families of six Children. So again, we have a cure cord down here that if you scan will take you to, uh, just giving page Abdo allow you to donate to this wonderful charity on 100% of the nation's that you make will be going to the East age. So I think, um, just before we move on to, um, doctor T today, um, I have some etiquette rules that would like to go see ear and some security things. So, as participants, you can see that you are not able to, uh, need yourselves and unable to, um, change your screen, internal video, things like that. So if you have any sort of questions that you'd like to ask throughout the Dettori Elise, just pop them into the chat on broccoli can be answered. Um, And again, be respectful. A switch any other online, um, events you go to and any inappropriate or offensive language that is shared within the story. A little night will result in you being removed from the session as well as being banned from any future E. P s events. So, um, I think on that heart, we shall. We wanted up 30 and for two nights tutorial. Lovely. Thank you, Claire. Super your introduction and facilitating this on. Welcome to all of you participants for joining us This for joining us this evening on Don't keep the time so that you do get get you to have your dinner tonight on depo Too long. But But I can't. Promise is to is to deliver all the information you need on before, for example, exams, but certainly will cover a lot of a lot of relevance. Topics on that will be very useful to you. Um, classy. You able to share the screen, or is that for me today? Give me a lot. So share your screen. I think it should be able to All right. And I don't see that. Yes, we can, Grant. So I'm a neurological overtime consulted pediatrician at Saint John's Hospital and hopefully, hopefully I'll meet Hurt some of you there in the way of future on. But I want Teo share with you. What? What? Communist and pediatrics. And what you don't want to miss on Diovan, Uh, teach you teach you something that you don't know? Onda make something more familiar that, sir, that or or learn more about that you're not sure about on down perhaps inspire you also in your careers or chosen careers. If you choose to choose if you choose pediatrics. So without that Maura do? Uh, well, it's not moving. Yeah, So the common presentations, all the common symptoms off Children presenting to our department on ever see a variety of reasons. So what? Um, I personally scared off and sharing. Sharing that with yourselves is missing a severe infection, missing cancer or missing a condition where management sooner would have changed the outcome for a child for the better common referrals that we see in pediatrics. Children with a fever, headache, abdominal pain, then president the rash we's on day. So but our Children small I that's the answer is, of course, they're not on that. But the question is, why? Why are they not small as out some? Why did they behave differently? So we know that they have a difference. Anatomy. Fundamentally, we know. Also, they have different physiology on different psychology of pain thresholds. So, um, in terms of in terms of there in terms of their anatomy on Diovan, more Children have got a large head and a short neck, for example, the floor of the mouth is compressible. They have a high anterior larynx. They narrow spot in their airway is the cricoid is the quick would ring importantly, and Children under the age of six months obligate nasal breathers, which means that they need me to breathe through your nose is there. If their noses are filled with the booties that you do struggle to breathe and that could be, that could be an issue in itself. Georgians breathing is also less efficient on day have very flexible rib cage is on Detrol cartilaginous ribs. They develop more recession. It's more efficient. And smaller airways, which can get easily blocked, hand additional factors. Obviously, Children, Children or below weight that and add up. And therefore they have a small, small God forbid. So it's small amount of blood loss can cause critical problems. They have a high body surface area, so they risk risk. Hypothermia and especially a small, small infant was a sense they breathe when they breathing. The, uh uh uh that infants have diaphragmatic breathing so they tire more easily on, but their airways could be more easily obstructed on both, with narrowing of narrowing with inflammation on disagree shins. They have a higher metabolic. Great. So they have a high oxygen consumption on DC, they're more prone to infection. There is a transfer central transmission or off antibodies, but that then that then wanes over the first over the first months of life on day, our smoke they obviously smaller on. But, uh, skin defenses are door on on, so psychological psychological factors are communication, difficult communication. Difficulties, of course, would limited speech in a small Children fear on dot. So what's then? What's important is the recognition with those limitations off the six child and when to call for help. So what we want to, um, in part to you is is the recognition of the child, or it's the recognition of a non well child. So to recognize whether the child is is well around. Well, we're looking really can't patent condition, but also but also got feeling, and we rely our on our own gut feeling. But also parents got feeling, which is why Children present present to us with their parents with their worried parents because they know that something is not right on. Apparently it's be listened to, so the approach is always a B, C, D. E and course. We have our fuse Chance Pediatric Early Warning Symptoms school, which is helpful, and those directors to call for help. But at the end of the day on, we don't just remind on any warning school systems, too, to alert us that your child is on well, so what's, um, what constitutes a well around, well channel? First of all, looking at the appearance negativity of the child's, they're alerting there's there, are in contact probably where they're where they're crying or unsettled or or, um, smiling and alert their work of breathing. These were all observations. So without even approaching a child who will often when they're separated, separated from a parent or or in or in an unusual situation, they will become very easily upset. So So observation is one of the one of the key, most important things that you have to do before you even approach a child or places that scope in my chest. So breathing, looking, of course, at the work of breathing, exposing the chest on, asking, apparent to do that and looking at the rate and rate and death off really on. The color with child is pale or pink or blue corporate freeze on capillary refill. So we have our traffic light system on, but this is the nice nice guideline. The traffic light system, which is which is useful. And it's a guide to directing investigations on a management in a non well child, so Children are highest risk. Not surprising, you will be in the red category on, but, uh, those who are not you don't need to be concerned about will be in the green category, so this doesn't protect perfectly well because there's a lot of information on this light. But what is what is important is, is what is what is in the what goes straight into the red red books so we can see that is the color color of the child. Hail, mottled blue activity. So no response. Listless child or a child with a high pitched, irritable crying, more respiratory grunting, technic raised respiratory rate to grace in 60 cents a minute reduced a skin tag and and other is the last In the last box age. Less than three months were imported. You took it a fever, but also another Children rash, bulging Continental. Next difference exception, so I can cover everything that we need to know about, Um, what's what constitutes the red box. But it's important to know that this traffic light system exists So danger science Important to know, Um, what normal? What normal is. So if we know what normal is that we know what is what is concerning. So it's dangerous i d h of child. So if we look at first, fever on top left less than three months of fever of greater than ankle to 30 degrees is concerning 3 to 6 months. Great of the recall to 39 degrees, and the duration of the fever is also important. We're looking at heart rate, so depending on the age that's there in the bottom left on da respect tree, great computer refill time off greater than three seconds and other pictures as per traffic lights is the importance of people. This is This might be very basic, but it's extremely important. Pediatrics on Big Guy does guide us in terms of in terms of investigations. So under the age of three months, old child with temperature of greater race, the Regal to 13 go straight into the red honest rations of red category between 36 months. Great of the recall to 39 is number, but over the age of six months. Interestingly, temperature doesn't correlate with severity of Wilmers to parents presenting with child with temperature or 40 or 41 on. That will be more concerned. But actually it's not a additional reason to be concerned because the child is over the age of six months. But certainly a temperature or 40 in a two month old infant would be very concerning. So we're thinking about the causes off beaver on the common common being. Common it off the list, so salty it's not. It could raise your Children is pediatric bread and butter, but it's two workouts And what other illness they they might. They might have a swell. So it's gastroenteritis, no respect. Tract infections, you're in the tract infections and then the less common, very important meningitis and calculators that septic arthritis, osteomyelitis and the rarer causes. And that's what put Kawasaki disease in that box, because we're always but it always in the back of my mind. So urine samples on why so every Parexel child under the age of three months on will have a urine sample collected clean catch, a clean catch, your example every Parexel child greater than three months, who has no focus of infection will have a urine sample collected so essentially a very low threshold for a urine sample being collected. Onda um particular interest in the jury is during the conflict. I'm We are seeing many, many Children with urinary tract infections, whether whether Kobe it those they're susceptibility rather increases that susceptibility to urine infection. That is, um, uncertain. But it's very cold headaches and shorter. So the headaches and Children are have got multiple courses. We have primary headaches. We have secondary headaches. So primary headaches see the most common tension, headaches and migraine headaches in Children. But secondary headaches. Um, Georgia, with acute paralysis on with potentially meningitis in capital itis. Acute severe systemic hypertension can present with a headache and raised in train your pressure. Of course, he's the Children that we don't want to be messing, and very often primary primary care will be concerned that that child who has a headache has a print shoe. And we're very keen. Um, for that child to be, um, scanned. Do it is important to think about this, but of course it's it's unusual. We need to think about teeth and, uh, Caries in in Children is very common on, uh um, dental care in, in our in our Scottish population is poor, and we do see a lot of it on a weekly basis. We have several talking with multiple dentist extractions under general anesthetic and its chief abscess, and and this causes this causes headaches. Medication could also cause or a test of medication use secondary headaches. So this is what we fear we've here. We fear a child with a brain tumor. The headaches will keep our red flags at some red flag symptoms in their history. So we have, um, signs off raisins. Cranial pressure, headache, which wasn't a postural change. We know that it's headache will be worse on line, on line down or or straining a headache, which wakens a child at night on degrees in a bit. But a symptom. Any symptom that weakens a child night is unusual and concerning. And let those for abdominal pain, joint pains and other pains, Um, a headache that is present on waking, especially if it's also associated with it. With 40. We have Children who are deteriorating school performance and generated school performance, you know, obviously a multitude of reasons for this and teachers are very readily flag up. Black, uh, problems to parents if they feel that the child is is wonderful. The whole school performance has changed Personality change. Onda Um oh, the look. And to see the localization or the location off or brain tumor if there was to be a space occupying lesion. This is very important in terms of what symptoms? A child my present with on be the first or the worst headache ever. Maybe a concerning feature off a subdirectory temperature or or other factor and Children under the age of five years or so, concerning on the same on both same consent for abdominal pain and other complaints. It's unusual for Children to be able to really localized pain or express themselves. So a child under the age of five years are clutching the head is reason to be concerned. So what we're looking for on examination, I'll see a very thorough, uh um, general examination and neurological examination, looking particularly for, uh, any abnormalities on a child with space occupying nation can have no have a completely normal neurological examination, so we can't be falsely reassured by this. We might see papilledema but again depends on the location of the space occupying lesion on Go on, Get his. And it was a late and it has a date sign. So again, not not reassurance that it it's it's or absence is not reassuring. We want to know height, weight. See if a child on gossip tickly important for Children under the age on to the age of two on. Which is why on are growth parameter chance We include three growth parameters length weight on a ref see on uh, you ever see is it is important that Children presenting next difference or bruit he's on on the skin lesions and escalations off. That's a new listing matter off neurocutaneous Interesting syndromes, for example, on gibberish. Close is, um, in in an older child, neurofibromatosis in a younger child. And then we moved on to absolutely ain't so, um, again, multiple multiple causes. Acute acute hepatitis. Propane on fewer calls is, but we have Children with on bursitis or other search for causes decay comprehend with abdominal pain and and a few other symptoms. You're really retract infection, severe constipation that would be unusual to present acutely, but it does Onda uh, what about recurrent abdominal pain? So the top of the list on most common functional abdominal pain? Uh huh functional symptoms. Functional headaches functional and on a function. Abdominal pain. Very common, but it's a diagnosis of exclusion, and we need to be very careful to Teo, not label it as functional, and that's were absolutely sure. But other factors might be a psychological on. But, uh, don't forget celiac disease. We have a very low threshold for checking. See, like antibodies on down flammatory bowel disease. On Do we do See Children a C on as 18 months, presenting with implantation of these disease force. That's very, of course, it's very unusual, but it's not to be forgotten a food intolerance or allergy, renal causes and constipation. And again, perhaps constipation should be higher up the higher up the list we get. But again, a diagnosis off exclusion but very common rid flags in recurrent absolute pain. So from said said earlier in the presentation that Children under the age off five years presenting with presenting with recurrent tummy pains, is to is wanting to be alert. Uh, closer. The pain is to the ambulance, the less the less likely it is that it's okay, and and then we see Children with fever, weight loss. So this is where our growth parameters growth parameters come in especially useful if we've seen tracking a child's weight. And we have a, um, a tracking record to see that Childers either lost weight or failed to gain weight as expected or recurrent fevers. Child with a poor appetite, altered bowel habit. Passage over blood on you guys past, um, mouth ulcers or perianal disease because both of those both of those can be associated with inflammatory bowel disease. The top and tail barry it off inflammatory bowel disease where we see mouth ulcers on perianal disease when we talk about altered bowel habit, particularly in induced loose stools or a change but urgency becoming continents and lachter. No, stooling is a very sensitive It's a very sensitive marker off off disease on. But, um, that's very important to ask specifically specifically about that and nocturnal nocturnal. Starting on a on a regular basis man is very abnormal. Joint symptoms, urinary symptoms on a family history off IBD again are red flags and included in that family. History is my only idea but any or two autoimmune conditions. And on examination, you mentioned growth parameters, height and weight in Children need to add in FC under the age of two. Any nail changes mount else is looking in the mouth is always important because the changes that we see microscopically in Georgia with IBD went colonoscopy and upper GI endoscopy a stand with with couple stone and abscess ulcer a shin and also be seen in the mouth. If you take good if we take a good look. So not only mouth ulcers or highlighters that's cracking around the mouth, indicative of iron deficiency anemia but also, um, couple stoning on tagging exception to an abdominal master up. A little tension is an abdominal tenderness, since particularly in the right or left arm. Yeah, um, is unusual because they say that spokesman Abdominal pain, often with with Harry Umbilicals, that central, central abdominal tenderness but right or left eye neck? Foster pain is a warning. Very anal disease. Always important to look at the Children's bottom of your childs, a child's bottom, even if they're reluctant to be examined. So he's in, uh, going on too enlarged influence, a very common on presentation in a very common referral on the parents are very alert to the fact that lymph nodes can be associated with a minor, pretty proliferative conditions of leukemia on we'll seek will come, uh, assessment very early on, but benign, benign and recurrent cyst. Uh, Vicodin president. It's really extremely common in Children, and you can imagine that a child is very frequently fighting often upper respiratory tract infection, and we'll have enlarged enlarged lymph nodes. But, um uh, but because he's but well, despite this and being common, the ones that we are on the lookout for other large months so in impotence that persist for greater than, uh, persistent great great for two weeks, um, are more interesting. But it's size on dumb, progressively increasing in size or tenderness or overlying skin. Changes over the nodes were cause concern. So benign, um, but benign, reactive. So Michael impose will generally be less than a centimeter in size and usually less than not 0.5 centimeters for the ones that persist. So associated with the topic, it's must have any. If there's any any skin inflammation, there will always be in large lymph nodes associated with infections for example, if you be glad to have fever, somebody talks a personal TB, HIV and malignancy. So, uh, it's very simple to arrange for a four plus count, which will exclude the majority of the problems. But what we said is the lymphadenopathy red flags will be weight loss, night sweats, pain, that skin rashes and on examination, what we're on the lookout for is a firm robbery. Non mobile, non non tender notes is the most worry once in unusual locations. So we know that prostate area cycle lymphadenopathy on down inguinal impacted off. The is really very common. But when we see supraclavicular accelerate or post auricular, lymphadenopathy will be more concerned. And a pale child with last includes worry Onda uh, don't forget to feel for the liver and spleen. Uh, but his father regularly very common in in front, part effective conditions. So then, having to think about the types of skin rashes some people like, uh like to have a thing about skin rashes on other people. Slightly dread to the child appearing with the skin rash on many of thumb at many of them are difficult to give a clear answer about to my good news story is that there are many types or rashes in in Children, but the bad news is they will look the same. So, yeah, it's, um it's a machine, but, uh, what we do, what we're thinking about when we see a rash with thinking about the age of the child. So then, no, I'm thinking about particular conditions associated with chick you know, rashes. Looking at the type of rash it is whether it's so hard to carry a little with those particular whether it's maculopapular and looking for for any other clues of the child. So know whether they're whether there was there. Any, uh, lymph nodes enlarged with the child has perhaps inflamed. Inflamed X Men really might have her excellent petticoat out whether there's any. There's been a chicken pox contact, whether they've been vaccinated or unvaccinated and may have measles. So a thorough history is very important for a child with a rash importantly, does the child little while or unwell? So go back to the basics. We're looking at the temperature heart rate response rate. Saturations had a really full time and then on then examination off off the child were asking about associated symptoms for example, upper respiratory tract symptoms. And he contacted anyone who has seen unwell on, uh, vaccination is strict. Uh, bread flax Depends are Z on the age of the child and parental, uh, concerns. An action plan then needs to falling. Does the child need to be admitted? Does Can the child safely be discharged home with safety net? The advice Do they need to be, um, seen again a day later? A week later, a month later for review and always safety neti safety netting was the place. So we have fun. A classic, a burek, a pure a crash So particular rash bureaucrat on off a bureaucrat of minutes a contraceptive See me, which was saying no very rarely with with vaccination. But this is still occurring and put pure crash off. You know she died so that is very office from them from that not only from the history but also from the spread off the rash on the type of rash spread spread rash and and how well the child is and see where the child have been. Trouble septicemia Child is clearly on well when they present with the rash that his florist on the child with, um he not sure I'm purpura or ATP is not a unwell child, a very different type of child. So with your with the popular crash a petite, particular ideal for the definition say particularly are lesions that measure less than two millimeters and nonblanching pop your, uh, between two and 10 millimeters and then once we're over 10 millimeters seven millimeters in size, over a centimeter in size, use the lovely word chemo sees, which isn't a great one stuff. But what about what about purpuric Rash were thinking about platelets from bleeding with thinking about infection. We think he also about trauma onda uh, vasculitis. So this is a common a common, very common rash on. But be aware that there is a quiz at the end of this presentation, just a very short one. So you might like to remember what you listening to that perhaps I should have told you that at the beginning of the presentation, but it always it's so erythema. Toxicum near near near tore, um, on babies born having beautiful, perfect skin. Unfortunately, within the 1st 24 48 hours, they become them invariably very spotty and less attractive babies with this very typical rash that alarms parents. Uh, this child baby presenting for a six week check. Uh, we're always very were always on the on the lookout for lesions that sound that are concerning and particularly particularly bruising and unexplained bruising. So this child with with not large lesions on their face on the six week on the six week old baby is clearly a reason for alarm and a history of an older sibling. Dropping a toy car on the baby is, uh, is not a history that we would we would accept. So child protection protocol for the management of unexplained bruising in non mobile in non mobile babies. Of course, as a force as a protocol, a protocol to be followed in these situations and I have some of you are familiar familiar with this or have seen a child child protection case. But certain protocol is followed in terms off history examination on further further investigations and social investigations. Yeah, so nonblanching lesion on the face of a non, really, while baby is a bruise on it is nonaccidental injury until proved for until proved otherwise. No matter a matter matter of generally what the history is with. So let's look at some family problems. So why do you want to Children know I'd Children present all developed every problem. So what? He said it earlier, earlier in the presentation was that Children and, uh, have a We'll see a smaller airway. They have. They have large. They have large tonsils that easily obstructed airway, their obligate nasal breathers. So they require their their noses, their noses to breathe. They have They're not necessarily for you fully fully vaccinated on down, but are under other prone to prone to certain infections particularly prone to here on the top, left a group. Then we've got mobile infants who put things in their mouth. They got an aspiration. We've got hair very large, large tonsils and tonsils and adenoids enlarge for the first eight years of life so it can cause problems for quite a few years. And small Children on do start and then start regressing. After that, we have Children with, um for mandibles been hypoplasia appear a bell syndrome on, but that can cause that can cause an issue. Uh, is well and here on the bottom bottom left. We brought a a child with them with swollen lips off. Anaphylactic reaction started. Carry a reaction. So you guys ing airway problems of deterioration. So the first thing is to, uh, go back to basics. Look at the work of look at the work of breathing. Look at the position off a child. Are they sitting comfortably? Are they sitting upright, looking looking and frightened? Tripod position listening. I'm listening without a stethoscope. But just, uh, listen to the audible noise off Strider, which is an inspiratory noise. We's, which is generally expertly noise. Listen to the quality of the cough on a child's in a child's ability to speech or speak. Rather, is a child drooling? Are they able to swallow their secretions? Are they looking anxious? Are they tiring? So where do we go ahead and how to reassess the work of breathing? The work of breathing is, um, essentially about recession. So you know, the Children have flexible, flexible rib cages and diaphragmatic diaphragmatic breathing. So we do see them on developing, um, quite marked into costal subcostal recession. And that's most clearly seen from from the side by raising, raising an arm and looking and looking at the side where there's where the least and subcutaneous that onda um, looking for nasal flaring, looking for sternal recession. A sternal recession is well, no. I have a few pictures of Children with the recession, so it's about effort on talked about efficiency on, uh, efficacy of a child's breathing pattern. So what are the common respiratory illness is the most common on the defendant. Season is so that bronculitis that we have fire and induce trees and smell. Uh, we, uh, Children with stride or on a cruise and cough. Teo. Beware of other causes of respiratory or rather breathing difficulties. So the child presenting with an abdominal abdominal problem, for example, peritonitis can present with what appears to be a a breathing issue, a child with DKA or shock and even poisoning. For example, if Salicylates can present with, um, breathing issues on thinking about coma, convulsions, raising cranial pressure. So it's about a bit of a natural thinking that's, um, breathing. Difficulties are not always associate are not always related to the chest. So thank you for a moment about, um, bronchiolitis on some of you being on the world's than then you'll be very familiar with this. So inflammation of the bronchioles, it's usually viral. RSP accounts for 75% of Children who have bronchodilators, but also other viruses, including Different A B heroic parainfluenza met in your virus, especially prevalent in the winter in November. Too much. But, um, most co bit with them, with Children returning to on childcare settings. The season last year was started in August and was finished by November. So so it's very unusual, but that relates to Children not having had earlier exposure to viruses. UH, breastfeeding does some protect Children against RSV hospitalization? It doesn't protect against RSV, but they do generally tend to have a mild on, Uh, Children from smoking environments are also at greater risk for specialization and what other admissions criteria, which Children are being most worried about. So they're those who have a feeding less than 50% of their usual intake. They may have marked recessional grunting and appear to be tiring on high risk infants. The groups that to a critically particularly look out for those who are experiment sure to have all have who have another lying cardiac condition at where not only looking at their work of breathing, but they're response rate and their situation and their oxygen requirement. Any therapy, any history of apneas and apneas could be the presenting symptom, all united in the smallest in the smallest sinosis and the diagnosis. It's uncertain, or there any additional social issues or a miller the threshold for its mission. And what about a child with acute? Keep tweeting Teo. They will present with a cough, wheeze and breathlessness, but not all acutely Resay Children res. They do sometimes have a predominant, predominant cough. Or we would call cough, cough variant asthma with much more cough than we, um, and and our breathlessness to under the age of find the most common trigger for oh, easy, acutely easy Absurd is a viral upper respiratory tract. Infections are very classically, the coryza all the Kerasal child presenting with We's about 24 hours after the onset off Kreisel symptoms Children over the age of five, more likely to present with other triggers not only just a prospectus shot infections, but also then exercise and error allergens. So under the age of five, we're very reluctant to do label Children with asthma, although the treatment essentially is the same and a child, maybe on prophylaxis under the agent under the age of five. Of course, as well. Teo limit the number of acute exacerbations to assessing severity or the over easy child again have a green number on red charts. So, um, have some of the things that were on the lookout for situations on whether a child is able to talk or two breathless to talk what the heart rate is, what the level of consciousness is with the Sinosteel magic dated. If it's possible that a peek at a peak flow is is useful, but a saturation is saturation, is that more helpful than a peak flow in the acute in the acute situation? Teo In summary, most Children with the common pediatric complaints have no serious or life a life threatening pathology. Remember, the red flags on assessment will help you identify the small proportion off. Children need further assessment on, uh, very important to always provide a safety net. So, uh, thank you. And since we have you to take any questions on any part of that presentation or other questions you might have, we could wait with those and do quits first, we'll see if they're already okay. Thank you so much, Doctor. Tea before I move on to the quiz, Does anyone have any questions? You can just pop thumb into the chat. And if you don't feel comfortable just publicly asking, then you can also just direct message me as well. And I could meet the question out for you. Um, there was a question a lot in the air. Um, that is asking, In general, in pediatrics watches the role of BP in terms of red flags at different ages. Oh, BP. Um, BP is included in our pediatric early warning system chart. That's pressure is extremely important to measure, but also very challenging to measure in a non well child, uh, much easier of a child. This is really very unwell to to measure of lodged up to measure of BP, but often measure your BP. Just just don't Just doing that can upset a child on Ben. Then then the opportunity to to fully assess the child is then lost. So we we will always check a BP certainly at at some point during an admission of a child. But Sometimes it could be very challenging. So we, um do you use it on early warning systems? But it has. It's separate it, but it But it can be very difficult. And, of course, if it's if it's if it's high, although it will be, it will be repeated. But it's challenging. Okay, Perfect. Does anyone else have any questions? Um also, could I just confirm doctor T that you'd be happy to, um, have the recording off this meeting and also the slides available for the students afterwards, but also no. Perfect. Okay, Onda, does anyone, um if any eye is suspected uring examination or concerns consultation off the child should the concern we discussed with the parents So, uh, the answer is the answer is yes, and it's always done. This is always a very carefully and each, uh, in each case, needs to be instant needs to be looked at us individually. Obviously. And it depends on the age of the child, the situation with the parents, and so on. But because super work, for example, of a child presents a child presents with bruising on. But the history the history does not match thie injury and there is. There is there is a concern race. Then we do not. We do know, hide it from the parents. What it is, that is and of course, can be innocent explanations. Which which of genuine? Where the toy being dropped on a child or older sibling causing causing bruising to it. Teo Younger sibling. But protocol in those situations and one in all situations. It will be explained to parents that, but finding bruising in a child uh, trick is a protocol and investigations Onda process is doesn't start rolling irrespective off. Um, really the explanations to keep or torsion safe on that's on that is that that it's the expiration that we give Children. Of course, it's very distressing when there is an incidence ablation and it's genuine, but we can't presume that. So we do, unfortunately, capture. Capture those those Children for whom there's an innocent explanation, and it can be very distressing for those families. I'm also starting off starting off the process on, But, uh um on DCA fronting or discussing it with parents can be extremely challenging If, um, if it is a non extended entry on there can be on it currents park aggression. Onda exception. So your police involvement of social work involvement on But it's a team. It's a team approach on the child protection team on will be involved in all discussions. And if it's an efforts, um, looking to be a difficult situation, then the child protection team will be involved even before the child has bean seen assessed and any mention off further investigations um, being made, well that the team will be involved. And I think we have one more question here. Um, and the child presenting with tonsillitis would you need to wait for it to subside before the tonsillectomy, assuming that they meet the criteria for surgery? Uh, yes. Unless, of course, it's, um, a portal. So, uh, total's around, says Quincy. Then that would be that that might involve acute acute surgery on it, or surgery and emotion. See, But it is generally not. It's generally even in those situations of the intravenous antibiotics waiting for waiting for inflammation. Settle down before a tonsillectomy. Perfect. Thank you of. Are there any last minute questions? Um, if not, we can What? We have one last question here. Sorry. Um, what is the best way to obtain a clean catch, urine sample and a child and nothing ease. Um, good question. So is a challenge. Uh, and it's usually a task Parents. Uh, so baby is a baby will be, and we'll be stripped of their nappy on be washed very carefully on, but apparently will sit with the child with a little sterile container and weight. So and the best time to catch your assessment is 20 minutes to 30 minutes after a feed. So So the idea is that the baby and then the strips and actually cleaned the baby on Dwight Urine specimens often missed. Um, boys are easier than boys are easier than girls, but Ford else fails. It's not CAFTA. An outcast, a specimen. There are little bags. That's a little plastic bags that can be attached to the perineum, but those are not used for sterile specimens. Those are used for a urine specimen that might be for your approaching crashing ratio for a metabolic screen or different purpose. So a nonsterile specimen, Um, because otherwise it's there's a wrist off off contamination, and we do not squeeze urine out of nappies. All those on be black ever done that in the past, but that's that's definitely a no no, We have another question here. Uh, what is the role off the e gs and and encephalitis diagnosis as they seem to take quite a while to get done, but and and stuff like just seems like quite a burgeoned thing. Ah, yes. Well, you just force helpful both in in situations off Difficult. Difficult? Yep. See on on also in in careful itis. But it's but it. But if there's a suspicion that letting hepatitis treatment will be your treatment will be undertaken with a sack of the upper spectrum antibiotics in the first instance, Onda, uh, there may be it may be easier to actually teo imaging before before, um EKG. So any GI is an added investigation on be really in the more complicated cases so we might treat for presumed meningitis and Politis Onda, uh, not actually ever get any GI Okay, um uh, you know, if anyone has any more questions again, you can pop it in the chart. I think we'll probably want to the quest now, if that is all right with you. Sure, Sure. There are 15 questions, some of them have got, um, within their quick within the within the question and embedded are saying a party. But essentially you could you can score yourselves on. Sure. Nobody which do you cheat, but it'll be. It'll be out of 50. So here, we're going to see if you've been listening. So what did This child sporting is giving a second for that. If anyone is comfortable with typing their answers into the check, they can. But you can also just write it down and take a note. If you would not like to do that someone saying that magic toy, right. Fantastic. Excellent. So this is this is magnetic. This was a challenge. Who or who was autistic? Use it six years old on. But he presented with altered bowel habit, abdominal pain, discomfort, weight loss and your center purposes was presenting his child with inflammatory bowel disease with a raised few car protective. He was being a prepped with prescribed Cytra mag pre colonoscopy on. But Mom gave me, gave me a call on his second sachet off central mag when she noticed in his napping because he was not to toilet train one c was autistic that there was a metal object. She came teo accent to the emergency that same evening on. But that's what the abdomen X ray had shown. She was He was He was a child who would eat and everything else on on a sweater. Lots of baby foods. But would would I actually eat, Uh, um, sand and and other and other objects, but yeah, he'd eat quite a few Magnetics and the result of that result waas that he on that because he's had traveled through his and bow. He required surgery, and he had numerous numerous fist. Really? Um, but luckily, he didn't, uh, And and luckily, he he, um He could have excisions with intervention estimates, isn't it? Require a colostomy and has made a a for cover. So, you know, watch yourself. The market. That right. So that was all he had started. So what's the most common virus causing bronculitis? If you listen to President, it's a very good yet rsv psa RSV. 75% of Children broken itis, but as a cent other virus and influenza parainfluenza met a new virus. Okay, so what's the diagnosis then? Yep. You with right? Excellent. Okay. Right sided you Month or X? Um, what's the rash and what's the most likely allergy? A topic dermatitis. Correct. X murmur. Yep. Excellent. So what we give away is the the actual X mark. And in babies is more babies. They tend to not have Flexeril next summer. They tend to have extra that covers the whole body's on, but, um, the their face, which makes it. And which place is very difficult on the most likely an urgent is is cow's milk protein. On the other things that Children small infants, religion to are soya X on wheat. But number one is his Cosmote pretty well school too. So diagnosis here, different child, same condition. And so it is. It is anaphylaxis on, but we've got some swollen lips, a scary a reaction and with the child on the right. But the Periorbital peri orbital swelling is, well, diagnosis hand and take us. Did it could be I to be good behavior ST with the chance to deal there with, um distribution off the rash, we have HSP, and the reason it's HSP is that the child is the charge is also same. I'm standing and she is not Maybe it is, or it isn't the same child with different plans on better. But it's the is the distribution off the rash, which, which is, which is what happened on the left? Actually, which with the pump, you're a be more over the extensive services over the over the legs. We can't see the buttocks there. But if the child is if the child is standing, then it's got to be a child who is not well. Otherwise, um, it be managed called a biological karash because it's purpuric, uh, diagnosis that just in a twinge, Old is that's right, the most common physiological. Joel This press press fit respite, baby jaundice on. But we are on the lookout for all the other causes off infant algae on this on down. It was very recently a child with a big hurry atresia. It's presented to us with pales, stools and dark urine on, but those Children tend to look a little more green than yellow, but they are presenting with with jaundice on. But the baby on the top picture looks, so let more looks like a child with more pathological cause than just am breast milk. Jaundice looks rather scrawny as I can learn a swell. So I suspect there's more going on there. But but neonatal Georgia's very common, but it's almost right. Text book about the causes causes jaundiced. What position is this child sitting in and what do we call this? And if we know that he has, uh, asthma? Are we concerned? So he is correct. Tripoding, um, so opening up, opening up his airways. He's got increased work of breathing. And then what would this be? It's bulging. It's red loss of light boxes. Light reflex. So otitis media correct about a bulging a bulging tympanic membrane. So your infection is very common in Children. You need natural of my natural. Could be, um, that both viral or bacterial on day treated so that recent antibiotics and suspicion is bacterial but the majority is say are viral. Recurrent infections can cause correct Squitieri otitis media and then and then hearing issues. If we look in the child's is and then waxy, it means that they've got no ear infection because, um, the hot ears and infected ears melt the wax Servant panic membrane is actually very easy to see, and they receive one that's rupturing your titers media. And, uh, what's what's this child? I got chicken pox direct. Very good. Very good. So on the particularly lesions which are drying on, be crusting over on day at various stages off very stages of development, slightly fresh looking ones on the arms and slightly perhaps older looking ones on on the trunk. But that's chicken pox, and we're seeing a lot of it at the moment. And what happened here? It's called a skin. It could be schooled. A skin syndrome on desk, all the skin, uh, as well. School the skin as a result of off a burn on S O burn from water is is certainly so mobile mobile Children pulling them. Um um uh, putting a hot drink over themselves is, um really not. Not uncommon on typical burn pattern. And what do we have? What do we have here, buddy of my computer? Um, any takers for this radiological diagnosis? Necrotizing enterocolitis tend to see with necrotizing enterocolitis you to you. You wouldn't see this kind of pattern because on its intramural, intramural capacity might see a perforation. But this is a congenital diaphragmatic hernia, actually. So what we see is the bowel. Um is the bowel in the chest? Um, it here. Bye. From attic hernia. Onda, Uh, what we have here? So newborn examination. We will be looking for Charles Red. Red light reflex Onda. Uh, this is what we see. Diagnosis, congenital contract. Good contract. No good reflex results. Reason could be corneal. So corneal scarring congenital cataract restaurant blastoma is a tumor and records is And what's this called for management of congenital dislocation of the hip. So it's called public Arness. Very good. Must be extremely challenging to copter baby in a public hardness. But that's what it is. And what is wrong with this picture? The spacer. Excellent. So all Children and and affect all adults should be using a spacer for their sick. You, um specifically for that storage inhalers you can use an IV a heyler for for the out in about situation. But MDI directly into the mouth is an absolute no no for Children, Children and adults. And this this kind of this kind of meter dose inhaler because it's very difficult. We know to cause an eight and in spirit inspiration with an activation off the inhaler. So that's what we need. We need to space it so you can add up the schools on. But, uh, that's what we'll end. Thank you. Thank you so much. Oh, hey, will chair. I scream just very quickly. So here I have. Um uh, you are coach here. You'll be able to scan. Um, that will hopefully take you to the feedback form for this event. Um, we would really appreciate any sort of feedback that you have on. Did also remember that the certificates off completion will only be given out once you've completed the feedback for him. Um, also on the feet back form there should be, um, a option to check out to request touch up. Content on do that will allow you access to both the sides and the recording a few days after today. Um, the link for the feedback if the cured isn't working for whatever reason is here Onda again our social media zahr all on the bottom of the side here, Onda So yes, make sure to feed out Said to complete the feedback form. Um I will just record in here on D. Yes. Thank you for coming