Paediatric- History taking & Physical examination of a septic looking child (Sepsis and septic shock)

Paediatric- History taking & Physical examination of a septic looking child (Sepsis and septic shock)Created OnApril 22, 2020Last Updated OnOctober 27, 2020byadmin You are here: Main Clinical Examination Paediatric- History taking & Physical examination of a septic looking child (Sepsis and septic shock) < All Topics Table of Contents History taking: Ask about patient’s data: name, age, gender Ask about history of presenting illness (clinical presentation varies) History of fever? Onset Duration Pattern Responsive/ not responsive to antipyretics Associated with chills and rigors? CVS: rapid breathing on exertion, SOB, palpitation, cyanosis Respiratory: rapid breathing, productive/ dry cough, wheezing, haemoptysis, pleuritic chest pain GI: reduced oral intake, vomiting, diarrhoea, abdominal pain/ distension, constipation, jaundice Renal: reduced urine output, haematuria, crying during micturition, changes in frequency, amount or colour of urine CNS: irritability, headache, fit, weakness, pain, incontinence, loss of consciousness MSK: joint pain, joint stiffness, joint swelling, limping, difficulty ambulating Skin: rashes, petechiae/ purpura/ ecchymosis, pigmentation, itching, discolouration Eye: red eyes, watery eyes, blurring of vision, diplopia Ear, Nose, Throat: ear discharge, hearing loss, nasal block, sorethroat, hoarseness of voice, muffled voice, dysphagia History of recent trauma/ injury Ask about antenatal history History of maternal fever? History of intrauterine growth restriction (IUGR)? History of chorioamnionitis? History of maternal infection? Ask about birth history Gestational age at delivery? – prematurity Birth weight? Mode of delivery? History of intrapartum complications? Intrapartum foetal tachycardia Meconium stained amniotic fluid Low Apgar score History of postnatal complications? – neonatal jaundice (NNJ), hepatomegaly, poor feeding, seizure, NICU stay Ask about vaccination history Completely/ incompletely/ unimmunized? Ask about feeding history Type of food/ milk Frequency and amount being fed Any reduced oral intake/ loss of appetite/ severe malnutrition Ask about developmental history Ask about past medical history History of diseases causing immunosuppression (eg. Malignancy, HIV, congenital immunodeficiency, etc) History of recurrent infections? (UTI, cystic fibrosis, congenital cyanotic heart disease, splenic dysfunction) Ask about drug history History of long-term steroids/ undergoing immunotherapy Ask about family history Chronic familial diseases? Ask about social history Living environment? Parent’s financial status and educational level? Recent travel? Physical examination: Anthropometric measurement: Weight, height, BMI, head circumference General Vital signs: temperature, heart rate (HR), BP, respiratory rate (RR), urine I/O chart Vital signs change throughout paediatric development, hence normal ranges are adjusted according to age Age HR SBP Hypotension as per SBP DBP RR < 1mo 110 – 160 65 – 85 < 60 45 – 55 35 – 55 1 – 3 mo 110 – 160...

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