Daisy is an 8-week-old girl who presented with non-specific signs of infection including a high fever. Her initial Early Warning Score was 9 which gave a significant cause for concern although this improved promptly as she settled. She was investigated and treated for suspected sepsis and underwent a full septic screen (including blood cultures, urine M, C&S and lumbar puncture) and remained in hospital for IV antibiotics and intravenous fluids for poor feeding. Over the first 24 hours of admission she developed increased signs of respiratory involvement and a nasopharyngeal aspirate confirmed Respiratory Syncytial Virus and she was diagnosed with Bronchiolitis; she went into Oxygen and continued on fluids, her antibiotics were stopped after 48 hours when blood, urine and CSF cultures were all negative. This worsening in hospital was very worrying to her parents but the medical staff were able to reassure them and she gradually improved after the second day as an inpatient and was fit for discharge after 4 nights in hospital.
By working through Daisy's case, it is hoped that you now feel:
- Confident with how you would take a history from and begin management of a febrile child.
- That you understand the need for reassessment in unwell children.
- That you have a better understanding of Bronchiolitis, including the:
- Aetiology
- Presenting features
- Controversy over management
- That communication (and miscommunication) are a significant part of Paediatrics and a significant part of delivering care.