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Okay. Good evening, everyone. Um, welcome back to our pediatric webinar Siris. Um, I'm very excited this evening. We have doctor side with this. He's gonna be delivering a talk on fever and rash. But for the doctors amongst you, we first have a quick message from the BMA. We're joined by Daniel Tyler. It's just gonna talk to her shortly and tell us about a little competition. So over to you. Can you thank you. So, yeah, I everyone, um sorry. This is only really relevant to, ah, doctors and med students. Um, but yeah, from the BMA. Uh, I work for the juniors and institutes, and then they're, um, essentially making sure that they're friends get the most out of membership and providing helping support to members. So, yeah, you were seen, uh, there's this would be a link in in sort of where you're watching from, uh, Carlin solve all sports on the screen, the moments of the QR code. So, yeah, this is the first mind that bleep have come along to. So far as you know, I will be a few more, but in all of them, CSOs so just quite exciting. The one of you watching the mind, The belief sessions will win a war. 100 lb Amazon actual we have to do is for you, like your code on the screen. So hold your phone up with the camera and I'll bring up the link. Oh, Oh. Use that Links in the chart. And And you went into the $100 Amazon voucher price drawer. So yeah, this is only available titers mind a bleep so of attendees where? Where? I'm coming along. So? So I would say the chances are quite quite high. Yeah, so? So if you miss, you know the doctor Enter. There's There's no catch. You're not going out to membership. It's just a way for us to keep in touch with you and give you some cough. Sounds like helpful emails. I mean, it doesn't matter. You remember already or not a lot. Just just just this forever and to enter. So yeah, So just for taking part is, well, you'll get it free to do the doctor inflammago eyes so again doesn't mean you're saying up to membership. It's just just a free support support back from us. Us to you regarding so very where you're being remember or not, but gives us a way of staying sexually. So yeah, I Even if you don't, when you get that guide ritual breaks down the junior doctor contracts. So So it's going over things like your pace that can relieve cetera. We negotiate the contract so we know what should be in it of inside out. So, yeah, pretty pretty relevant stuff. Even if you're a mess, you know, you'll still still be going on side contract one day. So you have that competition code will be in the top top corner of while I'm doing my new presentations. I've only got a few sites, and then I'll be done. So you feel free steel while I'm talking. Um, yes. So So just very beginning for me. I'm sure you remember you being a member at some point. Say no bit. About what? What the BMA does what? What we are. Um I still get with membership. So? So it's a little bit of a refresher, and everything might find out something new as well, eh? So it's actually we're leaving Trade union, Fresh association for doctors and the students in the UK s. Oh, yeah, Well, we look after you and with the voice of depression wrapped in you individually, locally and nationally so on pretty much everything that affects you. So what is your job? So the constipation is this is some toast or trying to cartia best we can s. So sometimes we get confused with them, you know, and and ps Oh, definitely. Companies went on in damage companies, so we don't like those guys we don't do with patient complaints. Were your union we had to look after your work efficiency, things like pay contracts, your your professional Telemann and also your wellbeing eso you may have heard of our of your of your junior specifically may have heard of are contracting cells, which would be the time to take quite a bit. Money s Oh, probably probably the keto for you guys to use. Ah, assume you've also had your contracts. At some point, I wouldn't be spies to some urine seen contracts yet, but yeah, uh, if you get your contract, we'll check a few of in five working days compared to the national model. We negotiate back in 2016 and then I'll see you renegotiating 2019, and only issues we can help get sore, so it's not always on purpose, but trust can slip in actual things. It's a contract. It'll change the wording to say things that ah, the opposite of what they should say. Eso this this common stuff that we see so we don't make sure contracts correct again. What it should be saying if you remember, you can send your contract into us on when we check it. If there's any issues we can take up with trust. We have people on the ground. Everything would trust in the UK, so we have being pretty much get erect. Device their way. Thanks very rare that it takes to know, um, 25 cent contracts chair last year were wrong. So one and four just too high number and always preference toe. Get it, take by the being made before you sign a baby. If you signed it on, it's wrong. It's wrong. Like it should have been like that in the first week. So there's a matter we can still get erect. I see that you've been assigned. You can also check of your rights compliant by using already checking some when you're entering hours or more know and will flag up to us If it's if it's wrong, well, again we get in touch. Ah, see, I just just a few figures there were on the standard sort of things that you might face is well, you can see the amount of cases and creating more know we've answered. There's no much do we haven't seen before that we can't help with. So so you always think of us. It's not your first part, of course, For any any issues. Um, yeah, we can take some of the pressure off. You feel you're you're facing anything you feel? No, you need support with, um we have, like, say, we have really ships of promotion will have every trust the UK and we have people on the ground and trust in the UK. Let's say we know who to talk to you and two things on your behalf. Eso yeah, just in terms of other things, like burning the, uh, stuff to help. Ah b m. A library has thousands of the books and journals recent services we can access from anywhere. S So this is This is also for students as well. You Ah be any library is currently closed so you can't get there in personal. But everything's all moved digitally anyway, so I can access things right away. Um, clinical keys are news tour. So that's essentially medical search engine making such conditions guidelines a drug monographs and then we'll step by step procedure videos you can access down your phone and that's up in the hope you sell diagnosed quick and dig down small tease. Our I also comes as a as an apple is well say really, really, really good talk to have in your pocket. You cannot see is our clinical non clinical going towards the upper Lexus BMJ Learning which has everything wasn't clinical models. I'll also get CBD points for every every month we do you print off certificates for everything you do as well get weekly security. BMJ is permanent just also just delivered every single Friday to address your regimen as you're not getting it, just make sure we got the right address view on Also, you can opt out and just have the the version I know somebody has serious of webinars. I wish you could watch live it on demand. If you think about especially explore, especially options already. We got talk with specially explorer on that I can help you get the big picture. That suits you. Best say that I was online. Psychometric testing takes about 20 days to complete last course. Lots of work, like bounce questions. Then it will give you the terrible listen, Stop to specially quality. Answer is given. I'm really, really easy to use and covers all, especially, is the okay, um, just near new things for me, So Ah, just move on to well being If any time you feel like you'd like to speak to someone by, well being, we have services, they're open 24 7 on that's open to everyone to doctors message in to and that it doesn't matter if you remember or not z e free. So yeah, that's the telephone based service that we do off the video. Causes body further again confidential, free of charge and and opens everyone, regardless of whether you remember. No. Um see, if you know what I remember, you could join the b m and pay nothing for your first month membership. Use that cure code down there. Different one. Ah, Could also opposed to in the on the chat as well. Um, so yeah. So that's it for me. Just one last chance on the competition. One of you over the over, the Siris of the best I could come to when the 100 lb. I was a voucher idea. Well, it's just a way for us to stay in touch with you. Um, yeah, that's it for me. I will let you crack on with the show. Thanks for having me. Thanks very much, Daniel, I think. Yeah, really excited. Real excited about that competition. Sira are financed. The surgery lead is sitting in the room she has already entered. She tells me I've posted it to the metal chats of love. Used to see it on later on, posted to the Facebook group. Um, but now that says my absolute pleasure to introduce Doctor Side, Um, you will be doing a talk this evening on fever with rash is a very common thing that lots of you will see, um, when working with Children, so I can hand over to you off your sight. Thank you very much. Good evening, everybody. I'm doctor Say you're very consultant. At the moment, working in stock mental hospital is very, and the topic is very, very common for pediatric people. Those were dealing in emergency are in their clinics. So basically all the subject of your periodically ended. But it will be very helpful even for our doctors to skill up their general knowledge because everyone may face a child with your rush, even adults with you and rash any time. So this little guideline and will help him to be more scareful. So this is the definition of fever. Most people will agree increase in body temperature more than 30 cents on fire you that mean a skin temperature of 37 are core temperature, which is a rectal temperature of 38 and this is the definition of rash. It is a visible ian of the skin Do Premarin skin disorder, a sign of systemic disease, but also and that mean anything which is not skin like is a rash so rational? Several child is something very common symptom complex for the Children attending in deeply clinic are in hospital attending emergency departments. So rash my pride, the only clue to an underlying infection. So seeing the rash carefully is very, very important. Maybe the hallmark off it. Continuous disease. So that may be only physical sign where you can judge that there's something serious infections disease on May be an early sign off a life threatening illness so rational because you leave you Yeah, that should be seriously view. No, you look for because off rash it is very simple. There are five Basically. Do you remember? If I've finger up your hand, you can remember What are the five groups which can call fresh infections allergy A hypersensitivity immune mediated bleeding disorder are you? Bet the defendant I'm losing a fever. The rash is extremely white. You can enter 100 of condition in differential diagnosis. A pre side diagnosis may not be possible on back side to a carefully street and physical examination. It working diagnosis can be made in many security. No, this is very crucial to make a working diagnosis for starting early trap e. They're appropriate and considering isolation, we have been necessary. No, the approach to diagnosis is simple. Like any other condition. We go with history. Age is that important because certainly group more rashes. Why I don't age group may have less possibility of infection stretches awesome. You know it's that important. A person had measles before dinner. I have next rash, although look me the like meses season is relatively important in the sense that, um, eating more common in winter and rubella and more in spring. Then you grab Your question is very important that which location destroying love and the rash happen part of them. Billion. Ask you in a tropical country may be simple insect bite, clever histories equally important, so that can give a clue and immunizing status is very important. That was a challenge. Fully immunized are not immune. So history topics for your very important and for your to who you write your things can cause rash. That's where the food water plants, animals, attacks in six infected human secretions and household contacts domesticating again industrial or agricultural products. Medication is is very important because rash maybe because off the medication used previously, no for drug rash, I will add that it asked me, Come on, the first dose off medicine given or may come 20 days after the last door, so we have to keep our minds open for drug rash that it's not necessary that every child using drugs for a week and know Rachael here on days rash can be because of drug. It could be sure sexually, still important teenagers And, um, you know, call pretentious. Important because you comprised Children R O own immunosuppressive therapy can. Well, unattractive rash is the cutoff unexpected infection seem to the boat. The rash are very important because many typical rashes may have a program, a period off illness, then general. Well being is important. Whole security child, Hopefully the child, while having rash timing off all sort of reg in relation to fever, is helpful in diagnosis. Many places then distribution and spread of rashes are sort epical in certain unless is, and that can give a good clue that work start off infection we are dealing then evolving. Pressure are changing. Appearance after only sector is also very useful. Then each ink, pain and burning off the rest is also important, although every right you'll have little bit of irritation. But some rashes are notorious for excessive itching, so that will be a good clinical clue. In physical examination, we have to be very ready, total and examination because membrane connect. I've genitalia. Leave your liver, spleen, urologic examinations. Kind of unusual irritation. Joint examination is that important? Complete body surface of the emissions that important, including scan. What a terrible evaluation of rush morphology of Lien is very important. So when we see the rash we should should be able to document were thought off it is distribution and extent of rash is very important. And then any evolving leans I'm really in got off Different age groups are different stages off appearance are well, this is that important morphology rash can be described in few terms Michelob are badge are flared dresses the fuse are the veins. Rashes No do is simply a bigger perfu. If it is more than five millimeter, it's garnered you Black is a crust on the skin like eczema. Blacks medically the flu she rash are far and belies a bigger medical and actually the posterior. So if we look at the skin so this is how I am. A cure will appear. The surface of skin is smooth Exactly. I mean, if you grow your eyes and move your hand on this skin, you will not feel the rash. But these are card medical ranches, audit patch. It wouldn't be good then Perfused are amazed. You'll feel a bump now. Do you lose it? Begin one and flaking just a question. Billion and medical are where you can see that probably didn't flu. So this is how you can identify your rash. Whether it is medically Peppler, plague are a physical and then describe the extent of rash and distribution. No offense. A rash is very helpful in diagnosis. If the personal fever and rash and there's mucosal and lung involvement. D 67 are the possibilities so that can that can help you never don't your defensive back. So herpes simplex Infectious mononucleosis is meters very seller Scarlet fever, toxic shock syndrome, Kawasaki disease handful, 10 miles. So you think of these If the king and because in involvement is here bombed insoles in your in your cocci mia hand for most disease meters And if he murdered for me Callous AKI disease Toxic shock syndrome, drug rash He's gonna roll Form them. So this commission so rash after appearance after a few days and start discrimination been feeding off the superficial layer of skin so that is correct of these 67 diseases Scarlet fever meters Stephanie, local scarred skin's in room toxic shock syndrome. Carla Sake disease, Steven Johnson syndrome, drugs, hypersensitivity and toxic epidermal necrolysis that excessive teaching. So although every rash could be a little bit itchy, but these are excessively each year, as you now take a TIA, you could box exema, insect bite, ears, scabies, secondary, shiftless and drug rash, and up to 2% of Children exposed to different medicine Midrin fresh, which are two million times more billy form rash, which is like measles like rash, are are educated. What's the theater? Physical signs are very, very important in helping to make a diagnosis. Meninges. Um, so many changes. I'm not common with the rash, but few conditions are associated with that. Number one is a good milk coffee mia. It may have signed. Um, you'll irritation that and drove irises are the simplex Lyme to the second associated Physical signs are tractors and are telling you for a few conditions associated with pain in The giants are swelling up. Cubillo calcemia this emanated Gonna call her disease rubella parvovirus B 19 fruits. You like phantom lined the dramatic fever. Richard, these are s. And here 90 model men will be dear with rash and fever. Liver liberty. If it is very regional, it could be because Brad's scratch. If it is survival, then three. Most common conditions are rubella, scarlet fever and cover. If you're a generalized, it is infectious. Mononucleosis is it's aggressive list toxoplasmosis. Sorry. And if it is John just excellent. It is most like SARC Randall's. Then four more infrequent. It's the child has a history symptom, and Chest X is done in a child with a fever and rash. These conditions could be diagnosed like mycoplasma. Well, still a zoster. Atypical measles are circle your estimation. So these are the basic investigation. We'll do get some rash. Certainly skin bags. He come in the end and serology also take some time. No diagnosis. So when we see you, Number one c. R. In clinic A child with fever and rash most of your time, it is very difficult to make it straight to a diagnosis. No, his diagnosis is important. Many time, not very important to make it just really bad side. But sometimes, yes. So what are the conditions where we can't walk off the bed, so I we don't do diagnosis. Do you have the condition? Fever with the rash in critically sick your child is very unwell. We have to make some diagnosis and start some in May Number one is Amos minimal. Well, you got Zemyia. 75% of Children have particular are for pre crash. But remember, rest may have simply maculopapular are bigger rash. The child is very secret underwear. My rash is arctic air. Really? Are that cooler? Please don't consider that it is not illegal. See, It can be scared. This is the appearance off. You know coffee, mia And in a ball state, it can be so what? Necrotic. But this is a rash of toxic shock syndrome. So usually, child present are a teenage girl may present with high fever and a bluish pink fine rash on the tummy, plus the involvement off bombs and four. So this will be the appearance Tall toxic shock syndrome. Of course, I'll be very sick as that high fever ready. Last physical signs improve this know once you have a future, the child and charges started recovering many time. Initially, we couldn't diagnose what is due. Zillions are you will see you in remission. Leg this whole building off. And if some glove is coming from the hand So this is a very famous periodic condition car, Stephanie, locals, cardio skin syndrome. This is because of toxins off step. Okay. And it appears that somebody has 50 child in buying books. There are multiple big, big blisters, but it is really not very sick. And this child need to be treated with antibiotics. And we have to care that as a lot of asking, you didn't know secondary infection of the skin of decide is that is that painful? It is, is painful. It's not nothing. All because I've seen a Children were comfortable, but they look very hard. It looks like, Yeah, Okay, big blister. Very superficial. Layers are ballooned up with flu alert. So possibly the nerves are not much irritated. So no pain. So this is another very critical condition card toxic epidermal necrolysis. So in this condition, usually the child is on long term therapy with antibiotics and maybe multiple anti the number of patient I was seeing for being treated by asking for osteomyelitis. So here the skin is spread in the middle of epidermis. And Irma's a lot of fluid leak, though. So giant present in part of hypovolemia in sharp, with a bluish purple early in on the skin. So that is the least year possibility, sometimes difficult to diagnose, that why the child is so much hyperbole. Me also my tachycardia. So much so low BP with fresh So the history, usually the child being treated with 23 antibiotics but the last 23 weeks. So once the condition progressive will become more obvious, it started peeling this, and if you force to be, that's this game. It splits up, so if you'll see the next slide, it can be lovely. And this sign is Guard Nickel XP sign. So when you press the skin with some, the epidural was weepy lot from them. Split it, okay, And this time I need to be given fluid in media tree and immediately on. The medicine should be really drawn, and we have to make sure their child is not going in acute renal failure. Many of Children end up in acute renal failure because of high pollen, because remission is usually presented. Lee. Yeah, this is Stephen Johnson syndrome it can happen usually after medicines. Oh, it can happen from infection ALS. And if the mucus lysing war, it can cause D A hemorrhage, which is very dangerous. And first thing is, unfortunately, if clinically well in war. So then you have to be big, hard to see if the be in an ice because many times can lead to it hands. This is, you can say rash off color socket disease, which is also quite common condition. And most important thing is you look at the eyes, The commute. I was quite red and congestion, but didn't know bus. So that can describe me all other pill until I just associate it with pill and disturb. So this is a septic condition. So the union covers will be having no period in discharge. And then because I've been bar bomb and solder in war and bodies and what are you doing? This acute rheumatic fever. Lucky we don't see that often, but just for a chemical stress I mentioned. So this is the rash up there. This is also a rash of acute, dramatic, cheaper card. It's hurting my marginated. Um, no. So these are life tracking condition where you have to make a diagnosis. You cannot read for long investigation to come. And dermatologist to help. You were all No. There are other conditions which are less life, track, name and can present with fever and rash. And these are the common condition to in this most common reason partly rashes. I have put in the last one so that we're not making this diagnosis. Okay, this is a nonspecific rash that is not a good baby. We should consider that nonspecific, violent illness in the end. In the beginning, we should consider is respecify I'll infection is a discordant fever Is the allergic rash are particular rash? Use it. You know, grass. You it added to my mother before me I do do the Henoch showman, but a lot. And if all these this is the last period, then you may be clear. Nonsense rash. Your child is very well. So this rash of scarlet fever It is God's sandpaper rash. So it's a very fine rash being crashed being funny. Papular rash. You look like a flushing skin. Only if you're very carefully pill painting it you may find very trying granule on the skin This is the lungs, the scarlet fever car red and strawberry don't. And if they're exudates, it appeared like this. It's got wife's. Probably this is a rash or rubella. You should be noted. Focus. Picture. My pretty generalized pink papular rash on child is usually quite well, other than sort of like a live in a bit, you said, as off the condition called a slapped cheek syndrome, who, basically the EKG looked like the billions of slapping the. But if you look at the body, it has a beautiful lacy type of grass and little bit railed about separate. So this is not a big mistake and as a martyr appearance that mean shock. So it is basically felt people on. But this is rational meters, and this is the culprit spar, which are there before the skin rash appear. And you said the rash, which appears men. This complex parts disappeared, so this is typical rash in measles and start from neck and behind the years and takes a couple of days to spend up to the legs so that factor in off progresses very typical immediately, And Charlie's usually very, very sick, mean measles rash This is a rash off rule you lot in. Think now this rash is mostly confused with measles rash. If you look at both appearances, that is seeming. But I tell in the end how we can clearly discriminate between the This is a national human might be for me that can you got infection or grow. And they are typical target like leans. This is the rash, which is very horrible looking, but child is usually very well and, actually and pepper and this part broke and she is really very typical on the extensive service of arms and buttocks and legs. But it can be so. Then you're looking at something, But you really child, is that even? Listen, I got a rash. This is more off Lamictal interest. It is called Gianetti Cross T syndrome. No, this rash has typically involvement of geeks and legs on there. No much. Only trump. Well, that's Russia. Initially, what do you do? It was associated with hepatitis B. So many people started believing that it is the hallmark of hepatitis B. Little people have reported so many viral infections so stable with this go down, possibly they just remained in books as an academic. Interesting. But I'm so all these pictures and all this information may help us make a diagnosis. That is it. Rather than especially crash a nonspecific classic mean whether the measles, mumps, rubella, scarlet fever on any particular position, we can diagnose from the rash. So if we're not able to make a clue many time it happened, that rash doesn't give a group that what exactly is the underlying diagnosis is. So before we surrender and walk off that it was announced that last you I'll give you a clue. You can Still, Daniels, you remember this sentence. Really very sick persons must less If you remember this, you can still make a diagnosis and how it can help mistake. So these are number of fevers ran the rash appear. So if you're as you're beating after one day of fever, it is either Rubella are very self chicken pox. If the rash being after two days of fever, it is scarlet fever is the national meeting. After three days of fever, it is small. Luckily, it is gone. If the rash appeared after four days, it is knees is and a recipe in five days it will ruin your life. And remember I told you that the rash of measles and Reuben's And, um, it seems it's hard to remember that rather than four day or fever or five years, then you can miss variables. But clinically, it is very different in leaders. There's a week, uh, prodromal symptoms running no cough riser. And then he would have stars. And on the fourth day of fever and the peak of less in general is very, very sick. The measles rash appeared while inaugural and friend um, diet and a few of foreplay bees, if you were completely sectors and child is very well. Yeah, she is rash appear on a febrile healthy either Covered. So many people blame to the medication which was you during that five days off illness Some Amoxil Some distract lower that possibly it is a drug that, actually these rules your length the rash of years after your temperature, your sector on a healthy child, it is rose your life so you can make a diagnosis. And we were very common rashes through there in front of his great common. But you have to very careful making a day. Thank you. Okay? Thank you very much dot Side. Is there any advice you would give to, um, the audience if they perhaps haven't seen lots of rashes before, You know, maybe for quite a junior doctor or New York, I and D I believe they should have our own eyes and little discipline approach. It can help. If they are scared of rashes, then they will not end up in any diagnosis. So little discipline abroad, whole security child. But in the distribution of rash, what is the fetus home? It is. He would have been rash. Appeared and more. Follow your rash. Anybody or more phys. Um, like chicken pox. Rush is typically no, Marty, you can see pep you You can see past. You'd you can see vertical. You can see Christian billions seem insane vision or anything. So the blue mark is, um, can help diagnose. This is chicken pox, which isn't updated on that. Then, of course, dealing off skinny the tractor. So every have some associated features. If you keep in mind, that can give you a group. And if you guys very, very unwell, then we have to consider the life threatening condition. Okay? perfect. That's what That's really helpful, actually. So, yeah, look at the whole child. See how sick they are. Go out and see lots of rashes and then let's say the nice kind of organized, structured approach. So I got a question from someone watching. Judith Hafford said, Can you recommend any resources for helping to learn more about rashes, impedes or that I can direct? I think all these conditions are discussed in different to, you know, chapter the books for particularly in infectious diseases. So they should make themselves because family really rashes. And when the patient come try to get your diagnosis and remind themselves their this is the real rash off this condition. So once they start learning gradually, really get confidence and certainly get some expertise in the last. So it's off the relation and repeated of the wrist. Yeah. Okay, thank you. And I will add my own results is well done. That, uh, Z has lows of good quality pictures of rashes. So I will say some of the diagnosis on there are quiet, quite specialist in niche, but they are very good quality pictures. Yeah, that you're struggling, turning. I also just learning because everyone was afraid of, you know. But then I talked better to learn it rather than staying scared. No, I think that's very good advice. I know when I see it. Like any sort of derm condition. If someone was quite junior, I'm definitely a little bit a little bit frightened of it. But I think no, I will take your advice in them. Trying got See as many as I can get. Get that experience to, uh, rashes and the total. His speech and examination. Little methodical a brooch. I'm gonna head learning me briefly about the common condition. How they present what? What What are they associated features? All this is quite helpful. And then if Unless there any other questions coming up, um, I just want to highlight that I have I've posted in the chat a link for the feedback. Please do take a couple minutes just to give us some feedback. We want to hear what you think we like to, you know, see if there's anything we can improve on. Well, if we're doing good stuff, we want to make sure we carry on doing good stuff. Um, so do fill it out and you will get a certificate to say that you attended. Um, I know that's very good for the doctors. Also, any a piece and pas, they're building a portfolio. It does show some good interest. The talk will be available both on YouTube on on metal catch up. Normally, it takes about a day or so to load up. Um, but thank you ever so much, Doctor Side giving up your evening to speak to us. So that was fantastic. So some people have learned something great player, so it will help. The Children were coming under their kids. Oh, well, thank you very much. I will. And the life stream there.