A Patchy History

Author: Dominic Higgs / Editor: Steve Fordham / Reviewer: Michael Perry, Amanda King / Codes: A4, CC1, R3 / Published: 26/08/2022

A previously fit and well, fully immunised 10 month old is brought into your Emergency Department (ED) with a 3 hour history of drowsiness.

He had been recently well, with a slight runny nose over the previous three days but no history of fever. His parents had given him a single dose of over the counter cough medicine earlier that day. He had been with his parents, and the visiting grandparents, closely supervised for the previous 8 hours and there was no history of injury. Direct questioning revealed no other concerning features in the history.

Examination revealed a rouseable but drowsy 10-month-old boy sitting on mum’s lap. The airway was patent with a respiratory rate of 20 and equal bilateral air entry. Saturations on air were 95%. Pulse was recorded at 130, with Capillary refill of 2 seconds centrally and peripherally. He was responding to voice on the AVPU scale and pupils were small but reactive. There were no obvious lateralising signs. He was apyrexial and exposure revealed no external signs of injury or rashes.

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