How to spot the seriously ill child

Even though , the wild flowers are out ,there are still an awful lot of tipical winter illnesses about. Now all is fine, if there is an obvious mild self limiting illness like an upper airway infection, or gastro bug and things can be managed with hydration , simplified diet, mild pain and fever killers , decongestants and other over the counter treatments. Kids particular preschool seem to go through 4-6 viral infections every winter each lasting about 3 weeks. 1 week of mild warning and unspecific symptoms, one of full blown illness and one which usually shows some resolving illness.
How to tell the minor from the bad? How does one recognize the more serious bacterial illness like chest infection( pneumonia), bone infection (osteomyelitis) , meningitis , septicaemia , surgical tummy infection or illness , kidney infection.

First Babies - take your baby to the doctors if they: vomit more than once or twice , particular bile stained (green), if they take less fluids than usual, pass much less or no urine, have blood in their stools, are drowsy , have an unusual cry , cry more and are not consolable, are more floppy than expected, if the baby shows hard laboured breathing, (pulling in neck , rib and tummy muscles when breathing) , making a wheezy noise, if the baby looks overly pale or blue , has an obvious rash, especially if it cannot be made to blanch (disappear , when pressed on it).


The older the Child , the easier illness might be spotted, as kids can often tell you what the matter is and symptoms of illness become also more obvious. Chest infection shows with bad cough, fever, sweats, shivers, being off food, and feeling generally unwell, headaches, aches and pains. The child might appear breathless, breathe fast and be blue around the lips. Bone infection different from joint ache of viral flu, shows with high fever , severe pain (child avoiding to use a limb ). Surgical illness including kidney and bladder infection presents with persistent vomiting, sudden severe belly or back pain, child prefers to be still, uncontrollable prolonged fever, fluid refusal, obvious belly swelling, bloody stools, chronic diarrhoea, blood in urine , smelly urine.
Meningitis can often start with as little as a high temperature , a generally unwell feeling or looking child , a child being more tired than usual.
Studies have shown that severe leg and limb pains, cold hands and feet (particular in the feverish child) and pale dusky , bluish skin around the lips could be early and more specific warning signs for meningitis.
Other symptoms that might occur , can be a red or purple rash. Small spots develop at first in groups anywhere on the body. They often grow to become blotchy and look like little bruises, the child could have a stiff neck , severe headache, faster breathing, dislike of bright lights, drowsiness and confusion , repeated vomiting

Mums are always right!, if in doubt get your child checked out - luckily most illness turns out minor and self limiting in children! Seek the advice from your pharmacist , GP , ED doctor , Nurse. See your after hour GP service ! Geraldton has more comprehensive care than a lot of rural towns, including permanent paediatric back up cover to all emergency services. Don’t forget the grandparents and checkout some great online patient advice sources.

Helko Schenk
20 9 2010

Sources:
http://www.patient.co.uk/health/Meningitis-Symptom-Check-List.htm
http://www.abc.net.au/health/library/default.htm
http://www.racgp.org.au/familyhealth Family Doctor Home Advisor
http://www.healthinsite.gov.au
John Murtagh “ Patient Education”

The 4 hour rule , urgent and out of hour care in Geraldton

The 4 hour rule , which has been called the greatest health reform in 20 years has arrived in Geraldton form April 2010. The WA Health services has set a target of 98 % of patients arriving at an Emergency Department ,have to be seen , treated , transferred for further care, admitted or discharged within 4 hours. But the 4 hour rule is more . The 2 years Geraldton Hospital has to reach the target, involve a phase of measurement , monitoring patient flows from ED and in the Hospital , a phase of review and options for improvement, followed by a phase of implantation of changes and re measurement. The large Perth Hospitals have started working with the 4 hour rule process since April 2009 and have already shown great improvement in reduced patient waiting times , better flows and less ambulance blockades of ED entries. Geraldton Hospital has to look at it specific difficulties like growing population, permanent doctor and nurse shortages, distance to tertiary specialist hospitals and services, partial reliance on RFDS and transport issues for transfers to Perth. It’s ever hard working staff in all departments and managerial levels is required to come up with specific solutions for Geraldton rural circumstances and specific conditions as the solutions from success in larger city hospitals or the UK, where the 4 hour rule is worked for some years now cannot be blindly copied due to our specifics of thin population, large distances , low density of nursing and doctor staff. Speaking for the 4 hour rule is that it will commit health service , WA government and commonwealth to make available funds, it involves all hospital staff and consumer (patient) advisors , it is easy understood by clients and patient, it seems a good process to review and improve flows in existing setups, and it has already lead to improvements in the city hospitals of WA and that it is always better to envisage change than to sit it out. Against it might speak the initial increased work load for already stretched hospital staff, the temptation for managers to design targets around existing inadequacies as a senates committee review highlighted in Canberra this year , the lack of staff , and resources which is especially gross in rural Hospitals the increased workload it might present to rural GP’s in already busy surgeries, when patients are earlier discharged as the Rural Doctors Association says. What options have Geraldtonians got to seek urgent or unplanned as well as out of hour care? It is always advisable to ring your practice or dentist Ist thing in the morning and to make clear that you need to see a doctor or nurse urgently that day. Most practices will accommodate you, as they keep slots or even run nurse clinics or doctor on call clinics for that purpose. One practice runs Saturday morning clinics , and plans to extend this to 5pm-9pm weekdays, funding and interest provided. Other practices might follow suit. SJOG operates an out of hour clinic weekdays 6 pm to 10 pm and 9 – 10 pm on Weekend days. You can phone for advice on self limiting illnesses or directions where to attend by ringing health direct on 1800 022 222 or got to www.healthdirect.org.au. Your trusted pharmacist will also able to advice you, further Fountains and Sunset Pharmacy are open 8am – 8pm every day. And you could go to ED or be taken there by an ambulance, but please only use them for non walking and absolute emergencies. Some patients have to wait longer than others as the ED staff applies clinical Triage ( sorting ) criteria to determine the urgency and timely need of care, this being the reason why a cough or toothache, waits longer than a chest pain or road trauma , which might require immediate attention. Please keep in mind that all hospital staff always works hard within given resources and set frameworks and is aiming to provide best possible care. Finally consider to enrol at Durack’s for nursing training or become a mature medical student in Perth to bolster staff numbers for the future in truly rewarding and guaranteed never out of job careers.

Helko Schenk
28 6 2010
Sources :
www.health.wa.gov.au/fourhourrule
http://www.healthdirect.org.au