Last Friday 13 November 2009 as I was preparing to leave my clinic in the afternoon, my nurse came in and said there was an old lady with a small child who had just arrived and were waiting to be attended to. Seeing that I was getting ready for the weekend, she told me , "It's okay doctor, the child is just having a fever and rather quiet".
Silently I thought , regardless of the state of the patient, it was my duty to see him/her. The lady then came in holding the child close to her bosom. According to her, the child was already feverish four days ago before his mother, her daughter, took him for a holiday. The fever became worse when they returned the previous evening. She noted that the child had been vomiting and his lips had become blue.
I inquired into his birth, immunization, medical and hospitalization history, unfortunately she, the grandmother of this two -year old child, could not give specific and satisfactory information. When asked where the mother was , the old lady replied that she was at work!
I proceeded to examine the child, who was unusually quiet. His body temperature was 39.7 deg. C (normal body temperature is 36.8 deg. C). His lips were bluish, his skin was dry (dehydrated), his heart rate was very rapid and breathing was laboured underneath his T-shirt. His breath sounds were brassy and air entry was reduced on both lungs on auscultation. I could not really discern a heart murmur on account of the fast heart rate. I ordered for a chest-xray and noted opacity in his lung and the upper part of his heart (right and left atria) looked enlarged. I am waiting for the Diagnostic Image specialist to comment on the heart finding.
For all intents and purposes, the signs and symptoms suggested a pneumonia. I would have liked to determine his oxygen saturation but unfortunately we did not have the equipment (pulse oxymetry).
The quite child was, in actual fact, gravely ill! Not taking any chances and mindful of 2009 H1N1, I rang up the Pediatrician on call and informed him about the toddler's conditon. We set up a normal saline IV drip (20ml/kg), nasal oxygen (2L/min) and suppository paracetamol and packed him off to the hospital in an ambulance accompanied by our senior staff.
I ended up leaving the clinic rather late but I was pleased that the little boy was properly diagnosed and referred to the hospital for appropriate treatment instead of being sent home with a panadol syrup and perhaps an antibiotic, because he was... a nice and quiet child!
Silently I thought , regardless of the state of the patient, it was my duty to see him/her. The lady then came in holding the child close to her bosom. According to her, the child was already feverish four days ago before his mother, her daughter, took him for a holiday. The fever became worse when they returned the previous evening. She noted that the child had been vomiting and his lips had become blue.
I inquired into his birth, immunization, medical and hospitalization history, unfortunately she, the grandmother of this two -year old child, could not give specific and satisfactory information. When asked where the mother was , the old lady replied that she was at work!
I proceeded to examine the child, who was unusually quiet. His body temperature was 39.7 deg. C (normal body temperature is 36.8 deg. C). His lips were bluish, his skin was dry (dehydrated), his heart rate was very rapid and breathing was laboured underneath his T-shirt. His breath sounds were brassy and air entry was reduced on both lungs on auscultation. I could not really discern a heart murmur on account of the fast heart rate. I ordered for a chest-xray and noted opacity in his lung and the upper part of his heart (right and left atria) looked enlarged. I am waiting for the Diagnostic Image specialist to comment on the heart finding.
For all intents and purposes, the signs and symptoms suggested a pneumonia. I would have liked to determine his oxygen saturation but unfortunately we did not have the equipment (pulse oxymetry).
The quite child was, in actual fact, gravely ill! Not taking any chances and mindful of 2009 H1N1, I rang up the Pediatrician on call and informed him about the toddler's conditon. We set up a normal saline IV drip (20ml/kg), nasal oxygen (2L/min) and suppository paracetamol and packed him off to the hospital in an ambulance accompanied by our senior staff.
I ended up leaving the clinic rather late but I was pleased that the little boy was properly diagnosed and referred to the hospital for appropriate treatment instead of being sent home with a panadol syrup and perhaps an antibiotic, because he was... a nice and quiet child!
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