ER Doctors

Fever in Children

creativeberry — Mon, 01 Jul 2019 14:06:43 +0000

Fever in Children

by Dr Marelize Vlok

FEVER

Fever is not an illness, but a beneficial response of the body to illness.
Fever is not harmful.
Fever does not increase the risk of seizures / dehydration / brain damage or death.
Fever will return until the illness is better.
Strict control of fever is rarely necessary.

INFORMATION FOR PARENTS

Tepid sponging is not recommended.
Do not over- or under dress your child or wrap your child in heavy blankets.
Let child drink fluids regularly (Breast milk best for breastfeeding children).
Speak to your doctor / pharmacist about correct medicine and dosage for your child.
Check on your child during the night, but there is no need to wake a sleeping child to administer medication.
If fever is not better within 48 hours or child’s condition is worse, seek medical advice.

FEVER MEDICATIONS

Paracetamol (eg. Panado / Calpol / Empaped)
Ibuprofen (eg. Nurofen / Ibugesic)
Mefenamic Acid (eg. Ponstel/ Ponstan)
DO NOT exceed the prescribed dosage / dosing interval.
Use measuring spoon or syringe.
Never let a child drink directly from the bottle.
Store out of reach of children.
Use medications to make child comfortable, do not use routinely to reduce temperature.
Antipyretics do not prevent febrile convulsions
If temperature doesn’t decrease after dosage, do not repeat dose immediately. Stick with dosage schedule.
If child vomits immediately after dosage, repeat dose.
If possible, try and avoid combination products.
These products complicates dosage and may increase the risk of overdosage and/or side-effects.

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It’s Flu season – be prepared

creativeberry — Mon, 03 Jun 2019 07:18:37 +0000

It’s Flu season – be prepared

by Dr Marelize Vlok

What is the flu?

The flu is an infection that can cause fever, cough, body aches and other symptoms. The most common type of flu is the “seasonal” flu. There are different forms of seasonal flu, for example, “type A” and “type B”.

All forms of the flu are caused by viruses. The medical term for the flu in “influenza”.

What are the most common flu symptoms?

All forms of the flu can cause:

Fever (temperature higher than 37.8’C)
Extreme tiredness
Headache or body aches
Cough
Sore throat
Runny nose

Flu symptoms can come on very suddenly.

Is the flu dangerous?

It can be. Most people get over the flu on their own, without any lasting problems. But some people need to go to the hospital because of the flu. And some people even die from it. This is because the flu can cause a serious lung infection called pneumonia. That’s why it’s important to keep from getting flu in the first place.

People at higher risk of getting very sick from the flu include:

People 65 or older
Very young children
Pregnant women
People with certain other medical problems

Is there a test for flu?

Yes. There are tests for the flu. In most cases, your doctor can tell if you have the flu by your symptoms. But in some cases- for example, if you are at risk for having other problems caused by the flu-your doctor might do a test (nasal swab) for flu.

How can I protect myself from the flu?

You can:

Wash your hands often with soap and water, or use alcohol hand rubs
Stay away from people you know are sick – at least 1.5metres
Get the flu vaccine every year– Some years the flu vaccine is more effective than others. But even in years when it is less effective, it still helps prevent some cases of the flu. It can also keep you from getting severely ill if you do get the flu.

What should I do if I get the flu?

If you think you have the flu, stay home, rest, and drink plenty of fluids. You can also take paracetamol of NSAIDS to relieve fever and aches.

Do not give aspirin to children under 18 years of age. In children, aspirin can cause a serious problem called Reye syndrome.

Most people with the flu get better on their own within 1-2 weeks.

You should see your doctor of nurse if you:

Have trouble breathing or are short of breath
Feel pain or pressure in your chest or bell
Get suddenly dizzy
Feel confused
Have severe vomiting

Take your child to the doctor if he or she:

Starts breathing fast or has trouble breathing
Starts to turn blue or purple
Is not drinking enough fluids
Will not wake up or will not interact with you
Is so unhappy that he or she does not want to be held
Gets better from the flu but then gets sick again with a fever or cough
Has a fever with a rash

Do not go to work or school until your fever has been gone for at least 24 hours, without taking medicine such as paracetamol. Always cover your mouth and nose with the inside of your elbow when you cough or sneeze.

Can the flu be treated?

Yes, people the flu can be treated with medicines called antivirals. These medicines can help people avoid some of the problems caused by flu and reduce the duration of illness. Not every person with the flu needs antivirals, but some people do. Antibiotics do not work for flu. Antiviral medications can be given to high risk people as prophylaxis.

What if I am pregnant?

The flu can be very dangerous for pregnant women. If you are pregnant, it is very important that you get the flu vaccine. You should also avoid taking care of anyone who has the flu.

If you are pregnant, call your doctor right away if:

You might have been near someone with the flu.
You think you might be coming down with the flu. In pregnant women, the symptoms of the flu can get worse very quickly. The flu can even cause trouble breathing or lead to death of the woman or her baby. That is why it is so important that you talk to a doctor as soon as you notice any of the flu symptoms listed above. You will need an antiviral medicine if you are pregnant and have the flu.

How long am I infectious after the Flu?

Influenza is spread by droplets in cough / sneezing. You stay infectious for up to 5 days after the last fever symptoms.

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Gastroenteritis

creativeberry — Tue, 13 Nov 2018 09:59:41 +0000

During this time of year we see an increased incidence of people presenting with nausea and vomiting (Gastroenteritis). This cause can be either viral or bacterial and affects patients of all ages, but is very common in younger children. The symptoms (nausa, vomiting, body aches, loss of apetite, weakness, abdominal cramps and headaches) are usually self-limiting and clear up within a week.

What to do if you suspect having Gastroenteritis:

drink plenty of clear fluids
stay at home and rest (at least until symptoms have cleared)
anti-nausea and diarrheal medication is usually not necessary seeing as symptoms are self-limiting – but are available at the pharmacy
it is easily spread, so washing your hands and avoiding contamination other surfaces, eating utensils etc should be avoided

When to consult your Doctor:

persisent vomting and being unable to keep fluids down (vomiting lasting more than 2 days in adults, more than 24 hours in children over 2 years and more
than 12 hours in children under 1 year of age)
fever
blood or mucus in the stools
during pregnancy
patient over 60 years of age
recent international travel history
patients with underlying chroni disease
patients with weakened immune systems (eg on cancer treatment, HIV etc)

Contact your local Emergency Room or GP if you have any questions or uncertainties.

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Spider bites – we do see them (and what to do)

creativeberry — Mon, 27 Mar 2017 10:56:22 +0000

In the week past we’ve seen two cases of spider bite that necessitated antivenom and patients ending up in the Intensive Care unit.
In the Western Cape we are lucky that we really only have to worry about three different species of spider. These are the Button -, Sac – and Violin spiders.
I’ll touch on the Button Spider first as this is the spider that (normally) would need urgent medical attention. We have two different types of button spider in the Western Cape, Brown and Black. The classic features of the button spider is the red hourglass shape on the belly of the spider (see picture). Depending on where in the Western Cape, the Black Button is normally the one that is more prevalent around homes. It is therefor more common to see gardeners etc. being bitten when accidentally squeezing one in the garden. These spiders are NOT aggressive and only bite to defend themselves.
The spider bite can normally not be felt straight away, but the red lesion becomes painful soon after (30-40 mins) can. A clinical syndrome we call Latrodectism then develops soon afterwards which consists of pain, spasms and difficulty breathing. The pain is normally the reason we would give antivenom. If you think you’ve been bitten by a spider, look out for these symptoms and if unsure, please come to the Emergency Room for us to evaluate.

Sac spiders are little brown spiders that bite without notice. They bite unprovoked and cause a nasty little red bite. It is quite common for children to be bitten in their beds at night.
There is very little to do about their bite other than treat skin infection, if it does happen (antibiotics)

Then there is the Violin Spider (see picture below). They are recluse spiders and only bite to defend themselves. I’ve not seen one of these spiders myself and have never definitely treated a bite from these. The treatment stays the same as with the sac spider, conservative and antibiotics if infection develops.

There are a lot of scary stories out there, but this is in essence what you need to know. For the people wondering about Rain Spiders, they are big and scary, but a nasty sting is the most you can expect from them (unless a skin infection develops). Again, they are not aggressive and only bite when provoked.
Keep safe out there!

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A new unit…..soon

creativeberry — Sun, 04 Dec 2016 12:31:50 +0000

As some of you might know, Louis Leipoldt hospital has been undergoing renovations in the past year. Soon it’ll be the turn of the Leipoldt medical centre! Luckily the Emergency Room will be included in these planned renovations. We’ve seen the plans and it looks very good. We are awaiting final approval and dates, but 2015 is going to be a big year for the unit……

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How to prove you have a medical aid when you cannot talk..

creativeberry — Tue, 12 Jan 2016 12:42:25 +0000

I was recently asked by a sports person as to how an ambulance or private hospital will know if you have medical aid if you cannot speak for yourself. I’ll try and give a few pointers as to carry your medical aid info without having to have your card / ID on you.
While it stays advisable to always have some form of ID/drivers license on you, there is a way to prove to either a private ambulance or private hospital that you are a fully paid up member – even if you cannot talk for yourself.

Most ambulance personnel are trained to check your phone for ID, contact information and to get an idea if you do have medical aid. They swipe your locked screen and access the ICE Medical ID page to assert this.

Please click on THIS SITE for more information as to how to put a ICE contact and other info on your locked screen.
I would suggest to keep a scan of both your ID and medical aid card in an email or if you’re tech savvy to keep it in a cloud account (like Dropbox/Box, etc) so that you can email this to the relevant person the moment you wake up.

Please check with your medical aid if they have an app that makes this process even quicker….
Remember this can save your life!
Stay safe people!

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My child swallowed a coin……or did she? What to do….

creativeberry — Tue, 15 Sep 2015 12:40:53 +0000

We get asked the above question weekly in the ER. Parents arrive with the history that they think their child swallowed a foreign body. We as ER physicians sometimes will get a call from concerned parents, and it is always difficult to know the outcome straight away
The reason for their suspicion is normally associated with the child stating that they swallowed something, or the parents witnessed the event.
For this common complaint, we luckily end up having to do very little in most of the cases. As this very good article explains…..(see link)
Advice for parents:
1) Make sure the foreign body was not inhaled rather than ingested – this is a much more urgent emergency. The child will have coughing / wheezing / respiratory distress. This should be taken to your nearest ER as soon as possible.
2) Most of the ingested items will pass harmlessly through the gastrointestinal tract. If the child is not in severe discomfort straight away, it is of utmost importance to know what was swallowed. Small batteries are very dangerous, as many articles (see link) of children dying because of this will show.
3) Use common sense to assert of there is drooling / discomfort on swallowing / abdominal pain / coughing or vomiting blood after the event. If any symptoms, rather get it checked out.

As stated before most of these cases will resolve without further issues, but some do not. I recently had friends’ child swallow a coin. My advice was as above. The next day the little one had dysphagia (painful swallowing) and parents quite rightly took her to her doctor, who took an X-Ray and found a coin lodged in the thoracic inlet. This coin caused discomfort and would not pass by itself and thus needed to be removed under general anaesthetic.

There are not hard and fast rules after initial first aid, but a good dose of common-sense. I stick with my belief that if the parents are worried, I should be worried.

I’ll write something soonest about children and swimming pool care, as the season for open pools approaches…..

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My child has got a FEVER……

creativeberry — Mon, 20 Apr 2015 12:23:56 +0000

With the seasons changing, we’ve seen an increase of children with fever in the Emergency Room. This fever landscape is sometimes very difficult to navigate and parents should have a plan as to how to react to a fever. Most kids will have a fever illness every year, and parents WILL have to deal with this.
Most of these illnesses will be viral infections and self limiting, but there is also the more dangerous bacterial infections, which is still the biggest killer of children under 5.
So how do you know?
We as doctors don’t always have the correct answer as to what infection a child has got, we are trained to look for the illnesses that can develop into something more dangerous. This is why you sometimes will see that your child’s diagnosis might change once or even twice while in hospital, even under your paediatrician’s care. At Louis Leipoldt we are extremely child friendly and always keep your child’s health first. We try and admit the sicker patients and will probably prescribe home medications for the children that can be managed at home.

So what is fever?

Fever is a recorded temperature higher than 37.5 degrees Celsius (C) in a baby older than one month. We measure fevers with a digital thermometer in the child’s axilla (armpit) in the case of children younger than 5 years old. For children younger than one month (four weeks), temperature is not a good gauge of illness.
In children older than one month and younger than five years, we think about fever as mild (or low grade) which has a temperature between 37.5 and 38.0 C. If their fever is higher than 38.0 C we see it as more serious.

Why fever?

Fever is a normal immune reaction to an infection, be it viral or bacterial. It is an evolutionary response of the body to change the environment for viruses and bacteria to grow in. In this sense not all fevers should be treated, but seen as a normal response to infection.

How to treat fever

If your child is uncomfortable, then fever should be addressed. See this helpful guide as to how to quickly treat a troublesome fever. Remember this guide is American, substitute Tylenol for our Panado and Advil for our Nurofen.

As a rule of thumb I always tell parents that Panado can be given four times per day, and Nurofen/Ponstan three times per day. Remember not to give Nurofen/Ponstan to children under 6 months of age!
If you struggle with getting a fever down, use Panado and Nurofen/Ponstan alternate every four hours. When the fever is under better control, you can think of switching to Panado and Nurofen TOGETHER three times through the day.
With Calpol entering the market, please be mindful that Panado and Calpol is one and the same drug – Paracetamol. Paracetamol is called Acetaminophen in North America.

REMEMBER, if you’re unsure about a fever, we are open 24/7 and there is always someone to assess your child’s fever and help you try to make sense of the reason for the fever.

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World Cancer Day

creativeberry — Thu, 05 Feb 2015 12:25:20 +0000

Today is world cancer day. Let me take the opportunity to write a little about cancer and the way we would see it in the Emergency Room.
We have a few scenarios where we help people with cancer. Can I first explain that cancer itself is not a diagnosis. The word is a collective term for a group of diseases that compromise those that include the abnormal overgrowth of cells.
We sometimes see sick people that we have to make the diagnosis of cancer. On the Louis Leipoldt Facebook page I shared an example of a man we diagnosed in the ER with a brain tumor.

We also see people sick with their cancer, be this as the cancer takes it toll on the body, or maybe the effects of therapy (chemo or radiation or both).
And then sometimes we have to deal with the end of life. This is never a pleasant experience, but we try and be as compassionate as possible. Please understand that this is as hard on us, as on some of you. Sometimes we have family members in the same struggle, or we might’ve lost a loved one ourselves to this.
I believe we all can add a little love to people in need. That is why I posted on the Louis Leipoldt Emergency Room Facebook about the Sunflower Foundation.

Please go have a look:
http://www.sunflowerfund.org.za

Please go have a look, or maybe find yourself a place to add some love. You never know in five or fifty five years you might be on the other side and wish you had done more.
JRB

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Hand Foot and Mouth Disease

creativeberry — Thu, 18 Dec 2014 12:28:57 +0000

As many of the parents in our vicinity can atest, there has been an increase in the amount of Hand-Foot-and-Mouth disease (HFMD) cases around our hospital.
We’ve had many children in our unit with rashes and with our recent spate of measles outbreak it has been difficult to find the cause of the rash sometimes.
Luckily most viral infections are self-limiting, but parents should educate themselves about the causes of rashes, but more importantly the major complications of measles. Please take a minute to read the WHO advice regarding measles.

More information regarding HFMD can be found here.
The disease is caused by an enterovirus, spread through droplets (coughing, sneezing) or stool.
There is normally a viral phase 3-6 days before the rash.

The rash is characteristically on the hands, feet, inside the mouth and sometimes on the buttocks. Even though I’m not the biggest fan of Wikipedia there are some good pictures here.

There is very little treatment necessary for HFMD. Keep your child comfortable, give Panado/Ponstan or Panado/Nurofen and some cold fluids. Calamine lotion can sometimes help to relieve the itchiness of the rash.

Currently we are more concerned by the measles outbreak, but this is a reminder of other diseases that can present the with some of the same symptoms and signs.

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