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Myth: ‘We know what a normal heart rate is for a child’


Playing devil's advocate here - Sometimes we need to put our "clinical experience" to one side, and just rely on the algorithm. I had a child with fever and tachycardic in my consulting room a while ago. Child looked ok. But no focus (other than pink eardrums, but what child doesn't have pink drums after a bit of crying), I was so tempted to say, "They'll probably be fine". Instead, I said, "they'll probably be fine. However, look at this traffic light triage system". I pulled up the NICE traffic lights for febrile children on the screen, and showed mum. "The heart rate is red. That means that even though your child looks ok, a few children like this may become seriously not ok in the next few hours. Could you take them to hospital?". Child had meningitis, sepais, antibiotics, lumbar puncture, PCR demonstrating viral meningitis, etc. Required lots of inotropes and supportive care to survive. It taught me that sometimes I should trust my gut. But sometimes, I should ignore my gut, and defer to the algorithm. I saw the child again recently, for nothing too serious, burst into tears after they left, and felt on top of the world for the rest of the day.

Posted date

26 Sep 2018

Posted time