Children's Unit
 
SF/E01/051: Joshua Trie
 
Child on bed
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Josh is a fit and well little boy. He has no past medical problems and is the apple of his parents eye. He was conceived through IVF after a long struggle and is very precious.

It is midday in the ED.

He is brought to the ED by his parents after they noted a rash on his leg and chest. He was irritable in the morning and has been lethargic with a high temperature. It was measured as 38.5 by his mother and she has given him Calpol.

On the way to hospital he became a little more drowsy. He was seen in Triage and a history taken. He was not examined in triage as it was a cold day and he had lots of clothes on. The triage note states that his temperature was 38C, that he was sleeping and has been off his food. He is triaged as Orange and taken round to the Paeds area.

On arrival in Paeds he is examined by the senior paeds nurse and the following rash is noted.

Your paeds nurse tannoys for a senior doctor to resus and meets you there.

On your arrival Josh has a rash developing across his body.
Elements of the rash are now clearly purpuric

Observations
A - patent
B - RR 34, bilateral air entry
C - P155, BP 80/40
D - P on the AVPU scale
E - BM 2.5, rash developing in multiple sites.