Summary Illness

In this activity we have seen Marley, who presented with breathing problems.

As the scenario unfolded it became clear that there was more to this case than a simple chest infection; in fact Marley had an empyema which is a condition where there is pus in the chest. Children with empyema can be really septic requiring significant levels of resuscitation (I have personally dealt with several seriously ill kids with empyema and it can be a challenge).

The whole point of this scenario though was not about reaching the actual diagnosis, rather recognising that Marley fell into the ‘big sick’ category and knowing what initial interventions would be appropriate. Knowing that there is pus in the chest is irrelevant in the pre hospital phase as you’re not going to try to get it out. What Marley needed was oxygen and fluids and rapid transfer to hospital.

The baseline skills you need to be able to spot the child who is in imminent danger of falling off their perch, is a clear understanding of the normal parameters of HR etc at different ages, and ability to perform a swift but detailed ABCDE assessment. You need to recognise the abnormal and deal with serious concerns as you meet them and in that way you will give the child the best chance of recovery. Rapid recognition of the seriously ill child is vital.