Non-blanching rashes

Cite this article as:
Ian Lewins. Non-blanching rashes, Don't Forget the Bubbles, 2017. Available at:

One of my first experiences of clinical research was in my first PEM job (depressingly, in the last century). This was work in what became known locally as ‘The Spotty Rash’ trial. A child would present with a non-blanching rash, I would heave a deep sigh and go and assess them before measuring EVERY SINGLE spot on their body and then documenting EVERY SINGLE spot on a body map.

ED attendance following MenB vaccination

Cite this article as:
Ian Lewins. ED attendance following MenB vaccination, Don't Forget the Bubbles, 2017. Available at:

In September  2015, the UK introduced the 4Conjugate Meningococcal B vaccine to the routine immunisation schedule, to be given at 2 and 4 months of age. Those of us who’ve witnessed the devastating effects of meningococcal sepsis welcomed this warmly. There was however a small catch. It was recognised that one of the effects of the vaccination was to produce a fever in the recipient shortly after administration, and parents were advised to give paracetamol.

This of course posed a dilemma to the ED physician met with a febrile infant post immunisation. Was the fever solely vaccine related or was it the presentation of a serious bacterial infection? Somewhat unhelpfully there was no, and still is no, national guidance on what to do. Do we assume all fevers are vaccine related and risk missing a septic infant, or do we assume all are possibly septic and risk over-treating?

Several teams in the UK are currently auditing their practices and publishing their findings. The first group to do so was in Northern Ireland  – publishing their findings in the Archives of Disease in Childhood. This is an important start to collecting data to allow us to come up with some guidance and to this end I have summarised the paper in the following infographic.



Cite this article as:
Ian Lewins. QTc, Don't Forget the Bubbles, 2017. Available at:

When I started my training, if you had asked me what the QTc was, I would probably have told you it was one of those funny shopping channels on cable TV.

Then cisapride came along (Google it, kids) and changed all that. Nowadays every colleague who asks me to review an ECG tells me the QTc. In fact, in many cases, it’s the first thing I’m told about. Not the rhythm, or the rate, but the QTc.

If I’m feeling mischievous I’ll ask why they’ve measured the QTc and what normal is. This often gets met with a nervous shuffling of the ECG.

So to rectify this and avoid further awkward silences I decided to produce the infographic below  – attempting to summarise everything you need to know about prolonged QT in one handy picture.