As a doctor, you have to be objective. You have to focus. Not to be distracted or too attached. Today, i learnt my lesson.
This is a history of a cute 18 month old boy.
He presented to A&E by GP referral with a 1 week history of cough, wheezing, and high fever of 39.1 degrees celcius which has become worse over a few days.
He was unwell since 3 months ago with consecutive episodes of illness first with tonsilitis, followed by croup, then gastroenteritis with diarrhoea and vomitting and most recently an ear infection. He was on antibiotics for the ear infection for 1 week.
He then developed a cough last week which is chesty, no obvious aggrevating or relieving factor, with onset of fever at the same time. He was off form, lethargic and not feeding very well. 1 day b4 admission he stopped taking any foods and drink only 2 bottles.
Mother also complained that he has lost a lot of weight since the 3 months he was sick
There were no other associated symptoms such as diarrhoea, vomitting, irritability or drowsiness
In the A&E he was noted to be pale and his O2 saturation was low at 88% . Upon administration of oxygen and nebulizers, the O2 sats returned to normal. He was admitted.
His paediatrics history was unremarkable. He was born at term, at 8lbs 11oz with no complications during pregnancy or birth. His neonatal period was also normal. His immunisations are up to date except for his pneumococcal vaccine which was missed 2 month ago because he was sick.
His past medical history was unremarkable. There were no previous admission prior to this. He was only in the A&E for the croup episode but was discharged. He is currently on these medications while in hospital:
Atorvent, Ventolyn, Pulmicort and Augmentin. There's no known drug allergy.
On the family history, there is a significant history of asthma in the paternal side of the family. But there were no other family history of congenital diseases, cystic fibrosis or other serious illness.
Developmentally he is normal. He started crawling at 11 months, and walking at 16 months. His vision and hearing is normal. He has a lot of words and understands conversations. He is sociable and interacts very well.
On examination , he's alert, apyrexial, pale, in no visible distress, has audible wheeze and cough.
His respiratory exam revealed mild wheezing and crepitation bilaterally. Air entry was normal and equal bilaterally.
CVS exam was normal. HS 1 n 2 with no added sound or murmur.
Abdomen was soft non-tender with no organomegaly or mass.
CNS intact, tone and power normal on all limbs.
His weight is now 10.44 kg (9th centile)
Previous weight in Sept 10.3 (25th centile)
So you can see, just by reading (if you've done paeds) probably you would notice by now that there is something wrong with this kid right? I mean, its not normal to be ongoingly sick for 3 months. His weight has also fallen across 1 centile.
But i got distracted because the child was very friendly, playing around, happy to be examined, cried when the stethoscope came out.. but stopped and held out his hands asking me to dukung him after i finished. waved bye bye by saying Di Di insted.. i mean how cute is that?
When asked by Dr C if i would worry about this kid, i said probably not..(on the basis that he is happy and playful and cute).. when she pointed out all the cues that i should have picked up..i was like, wait a minute, demmit, thats right..he could be having some kind of chronic condition... (cari differential diagnosis ye kengkawan paeds :P)
demmit laaaaaaaaaaaaa...!!! cute happy kids can have really chronic disease as well.. adeii.. lesson well learnt..
~shahied~
2 kritikus:
huhu..buat sweat test wehhhhh! plus kena focus on food intake. ada unsur2 FTT di situ. peace!
haha. lesson learnt : dunt be distracted by kids-cuteness :D
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