Last Updated on May 18, 2022
Triaging in ED
Primary triage
• GCS?
• The child is in dehydration/ shock / life-threatening condition?
• Infectious or non-infectious condition?
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💡 One the most important things at triage level is to determine whether the child is stable
Differential Diagnoses
Some common causes:
Infectious:
• Hand, foot and mouth disease
• Measles
• Herpes simplex virus infection
• Chikungunya
• Chickenpox
Non-infectious:
• Meningitis
• Stevens-Johnson syndrome /
• Dengue
• Kawasaki disease
History Taking
Rash
• Onset of rash in relation to fever
• Type of rash
• Distribution
• Spread / Progression of rash
Relevant history
• Sick contact?
• Allergy history
• Recent history of taking new medications
Physical Examination
Assessment of hydration status:
General appearance | Well | Unwell | Unwell / Deteriorating | Unwell / Deteriorating |
Consciousness | Alert & responsive | Restless / irritable | Lethargic / unconscious | Lethargic / unconscious |
Sunken eyes | Absent | Present | Present | Present - grossly sunken eyes |
Skin turgor | Normal (i.e. brisk // immediate) | Reduced (≤2 seconds) | Reduced (>2 seconds) | Reduced (>2 seconds) |
Offer Fluid | Drinks normally | Drinks eagerly | Unable to drink / Drinks poorly | Unable to drink / Drinks poorly |
Notes | ||||
Other parameters used for hydration assessment:
• Color of skin
• CRT
• Temperature of peripheries – warm / cold
• Pulse volume
• Pulse rate — tachycardia / normal heart rate
Any signs of shock?
• Compensated shock — CCTVR+ Tachycardia + Normal BP
• Decompensated shock — CCTVR + Tachycardia + Hypotension
References / Further Reading
- Day of appearance of rash in febrile patients [link]
Take Home Message
1. At ED, it’s important to determine if the child is stable and whether resuscitation is required
2. Children unlike adults, can deteriorate very fast
3. Always remember to ask regarding oral intake and diapers change frequency to evaluate hydration status