A three-year-old unvaccinated boy is brought to the ED by ambulance after two days of fever and vomiting, followed by lethargy and a rash this morning.
A clinical photograph is shown below. Initial assessment suggests bacterial infection as the most likely cause.
Clinical photograph of the rash.
List three descriptive features from the photograph.
(Marked out of 3.0)
/ 3
List four of the most likely bacterial pathogens causing this presentation.
(Marked out of 4.0)
/ 4
Other than bacterial infection, list three differential diagnoses for this presentation.
(Marked out of 3.0)
/ 3
His observations are AVPU responds to voice, pulse 180/min, BP 80/35 mmHg, temperature 34.5 degrees C and oxygen saturation 98% on room air. Your assessment is septic shock. Other than coagulation studies, list your three most important initial investigations with justification.
(Marked out of 3.0)
/ 3
State the details of your two most important initial treatment steps.
(Marked out of 2.0)
/ 2
Later, after initial stabilisation, a coagulation profile is shown below.
| Coagulation parameter |
Result |
Reference range |
| INR |
3.2 |
0.9-1.7 |
| aPTT |
83 s |
24-39 s |
| Fibrinogen |
1.7 g/L |
1.7-4.5 g/L |
| D-dimer |
35 mg/L |
<0.5 mg/L |
| Platelet count |
59 x10^9/L |
150-400 x10^9/L |
Interpret the coagulation profile.
(Marked out of 1.0)
/ 1
List four other potential complications of this presentation.
(Marked out of 4.0)
/ 4
Total Score: 0 / 20
Percentage: 0%
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