Infantile botulism

Milla is a 4 month old girl, brought into ED by her parents.  She’s been quieter than normal for the last couple of days and today seems really weak and not sucking on the breast any more.  On examination she has poor head control and marked hypotonia.  They also mention a history of constipation for…

Fever and a limp

2 1/2 year old John is brought into the emergency department by his mother.  He has been refusing to weight bear for four days.  Cite this article as: Sell, T. Fever and a limp, Don't Forget the Bubbles, 2014. Available at:

Finding the fever

Jed is a thriving 8 month old brought in by his parents with a fever of 38.8oC; he’s tachycardic and grumpy. His fever began twelve hours ago, and aside from crankiness, he is otherwise well. He is fully immunised and there are no sick contacts at home. You get a call from your Mixed Emergency…


A 6 month old child presents with cough and runny nose for 2 days with increased work of breathing.  She is working hard with moderate subcostal recession. Cite this article as: Goldstein, H. Bronchiolitis, Don't Forget the Bubbles, 2013. Available at:

Needing a Diagnostic Kick-start

A 4 year-old boy has been brought to the emergency department by his worried parents. He has had fevers for the past 6 days. They are concerned because he is not getting better despite repeated visits to a number of doctors. Each time they were told he had a viral illness. Cite this article as:…

Empiric antibiotics for general infection

Age if meningitis excluded if meningitis is NOT excluded if Staphylococcus aureus suspected < 3 months Amoxicillin 50 mg/kg q6hrGentamycin 7.5 mg/kg q24hr Amoxicillin 50 mg/kg q6hrGentamycin 7.5 mg/kg q24hr Cefotaxime 50 mg/kg q6hr Consider especially in infants aciclovir 20mg/kg q8hr Amoxicillin 50 mg/kg q6hrCefotaxime 50 mg/kg q6hr Vancomycin 15 mg/kg q6hr Clindamycin 15 mg/kg…


Definition: accumulation of lymphatic fluid or chyle in the pleural space (triglyceride level >1.1 mmol/l or total cell count >1000 cells/ml with >80% lymphocytes). Cite this article as: Anders, M. Chylothorax, Don't Forget the Bubbles, 2013. Available at:

Low cardiac output syndrome

Definition: oxygen delivery provided by CO does not meet oxygen demand (or CI < 2.1 L/min/m2) due to inflammatory response of CPB, myocardial ischaemia from aortic crossclamp, hypo-/hyperthermia, reperfusion injury and surgical treatment (ventriculotomy). Cite this article as: Anders, M. Low cardiac output syndrome, Don't Forget the Bubbles, 2013. Available at:

Febrile neutropenia

You’re working as the paeds reg overnight at a regional centre when ED phones you about an incoming patient – Josef, 8 – who’s in a delayed intensification cycle of his treatment for ALL and has a fever of 38.6oC. Josef’s last chemotherapy was last week, and an FBC done 2 days ago showed WCC…