An 18 month year old female child is brought to the Paediatric Emergency Department by her parents. She has been generally unwell over the last day, and not quite herself.

Her parents report they have noticed a temperature over the last 12hrs and became concerned when it didn't respond to Calpol and continued to rise. The child is normally active and well but today has been very sleepy and lethargic. She has also not eaten or drunk anything all day. She has vomited once.

She lives alone with her parents and there are no other unwell contacts. All her vaccinations are up to date and her developmental history is unremarkable. She was born at term by normal vaginal delivery after an uneventful pregnancy. There is no family history of note.

On Examination

  • Obs: RR-36 HR-130, Temp - 40.1, SpO2 - 94%, Capillary refill - 2 seconds

  • CVS- Mottled peripheries, heart sounds heard with no murmurs.

  • Respiratory - Unremarkable bar observations

  • Abdominal - Unremarkable

  • Neurological - Patient drowsy and difficult to rouse. Uninterested in toys and clings to mother. Will not open eyes to check pupillary response. Patient is unable to bend their neck. Patient is also very irritable when awake.


Answer one question before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. The first part of teaching will be spent discussing this case:

  1. At this point, what are you're differential diagnoses and why?

  2. What other specific examinations would you like to perform and why?

  3. What would this child's POPS score be, and what is it's clinical significance?

  4. How would you manage this child in the Emergency Department?

  5. The patient receives antibiotics and begins to improve, but one hour later she begins to fit. How would you manage this patient?

  6. What anticonvulsants could you use, and at what are their doses?

  7. How long would you wait for you chosen anticonvulsant to work and what would your subsequent steps be if your initial steps failed to terminate the seizure?