PEADS SURGERY

Denies allergy.
No pregnancy or breast feeding

Unable to contact in person
Mobile: Unable to leave message / Message left
Landline: Nill / Unable to leave message / Message left
Call back as required GP surgery / ooh 111 /
Walk in centre
Acute deterioration 999/ A+E

PROGRESSION / OTHER
No new or worsening symptoms or signs
No other acute concern's symptoms or signs

Meningitis check
Fever: Nill
Headache: Nill
Photophobia: Nill Ok with light
Nausea/Vomiting:Nill
No neck stiffness or pains
No none blanching rashes
/ Strep rash
Sore throat: Nill / Some
Ears: Nill obvious

Phone Exam
Sounds stable no distress.

PHONE ADVICE: URGENT A+E
Advised urgent A+E
Ambulance as required
Otherwise taxi or transport by other
States will arrange as quickly as possible

Phone Exam
Alert and orientated time place person
Agitation: nill

Phone consult:
GM Notes Checked:
Consult with

Feverish/ generally unwell
Travel: nill
Ill contacts: nill
Fever: Nill
Headache/ irritability: Nill
Photophobia: Nill Ok with light
Nausea/Vomiting:Nill
No neck stiffness or pains
No none blanching rashes
/ Strep rash
Sore throat: Nill / Some
Ears: Nill obvious
Cough: nill
Phlegm: nill
wheeze: nill
Breathlessness: nill
Eating and drinking:
Normal/
Bit less than usual amounts
Bowel Motion: Normal
Diarrhoea: Nill
Urine output:
Normal usual amounts
No dysuria

Review post weeks: 2/3/4/

Review post weekend
if symptoms not settled

Review post abx
if symptoms not settled

Allergies: ? Nkda
Medication: ? Nill
PMSH: ? Nill

TODAY:

Phone consult:
GM Notes Checked:

Phone Exam
Sounds stable no distress.
Alert and orientated time place person
Managing sentences No audible wheeze

RESPIRATORY Peadiatric
Chesty cough
Occasional murky sputum
Fevers: Nill / ?on/off
Wheeze: nill
Breathlessness: nill
Hx asthma:nill
Inhalers: nill
e+d: ok
n+v: nill

Phone Exam
Sounds stable no distress.
Managing sentences No audible wheeze

F2F Appointment needed (routine / urgent )
Patient will ring Extended access hub
/ own gp surgery / or ooh 111

RESPIRATORY Peadiatric
Asthma / copd
Chesty cough
Occasional murky sputum
Fevers: Nill / ?on/off
Wheeze: nill
Breathlessness: nill
Hx asthma:yes
Inhalers: yes
e+d: ok
n+v: nill

EXAM PEAD QUICK
Appears Stable Alert
No meningism /
Kernig / Brudzinski negative
t:
p:
hs: normal
rr:
wheeze: nill
crackles: nill
tracheal tug: nill
recessions ics scs: nill
Abdo: snt
Ears: nad
Throat: nad
Lymphadenopathy: nill
Rashes: nill

Safety net advice:
Meningitis / scarlet fever
Discussed signs of dehydration

? DNA:
>>>>> ? DNA >>> Reschedule / OOH 111/ A+E

F2F ADVICE: URGENT A+E
Advised urgent A+E
Letter given
Has Transport/ Taxi
States will attend as quickly as possible

EAR EXAM :
Appears stable Alert
No meningism / Brudzinski: Negative
Apyrexial
t:
Ear: Right/ Left
Pinna changes: nill
Mastoid tenderness: nill
Trigone tenderness: nill
EAC: Clear / waxy / inflammed
Discharge: nill
TM:
Normal
Dulled
red inflamed
Retraction: nill
Perforations: nill

Other Ear Right/ Left - nad
Throat: Clear

Eye exam
Eye Right/ Left
Periorbital changes: nill
lid/lashes: nad
Conjunctiva: nad
Scleral inflammation: nill
PERLA
EOM Full rom
Photophobia: nill
Opthalmoscopy : nad

Other Eye - nad

No obvious visual disturbance

5	6	7	8	9	10
60	72	84	96	108	120

EXAM PEAD FULL
Appears Stable
Alert
interacting
No meningism
Kernig / Brudzinski negative
No irritability
Colour/Tone: Good
Moist mucous membranes
t:
p:
hs: normal
rr:
wheeze: nill
crackles: nill
tracheal tug: nill
recessions ics scs: nill
Abdo: snt
Ears: nad
Throat: nad
Lymphadenopathy: nill
Rashes: nill

EXAM PEAD QUICK
Appears Stable Alert
No meningism /
Brudzinski negative
t:
p:
hs: normal
rr:
wheeze: nill
crackles: nill
tracheal tug: nill
recessions ics scs: nill
Abdo: snt
Ears: nad
Throat: nad
Lymphadenopathy: nill
Rashes: nill

EAR TREATMENT :
Keep ears dry
Abx oral: Amoxicillin
Ear med: otomize
Deny allergy:
Urgent attention if any acute deterioration
TCB / Review with own GP if not settled

EAR EXAM :
Appears stable Alert
No meningism /
Brudzinski: Negative
Apyrexial
t:
Ear: Right/ Left
Pinna changes: nill
Mastoid tenderness: nill
Trigone tenderness: Slight
EAC: Slightly inflammed
Discharge: nill
TM:
Dulled
red inflamed / slightly
Retraction: nill
Perforations: nill

Other Ear Right/ Left - nad
Throat: Clear

RESPIRATORY Croup
Chesty cough
Occasional murky sputum
Fevers: Nill / ?on/off
Wheeze: nill
Stridor: nill
Salivary pooling: nill
Croupy cough: nill
Breathlessness: nill
Hx asthma:nill
Inhalers: nill
e+d: ok
n+v: nill

Safety net advice:
Meningitis / scarlet fever
Discussed signs of
respiratory distress

Gestation: Term
nvd/ c sectio
Postnatal issues: nill
Feeding: Breast / Bottle
Formula
immunisatiions: utd

Allergies: ? Nkda
Medication: ? Nill
PMSH: ? Nill

TODAY:

IN THE DARK
See previous consults
No access to test results / opd letters

Likely Viral illness Common cold
Liaise with chemist
OTC Cough cold meds
TCB as required
Urgent attention if any acute deterioration
Review if not settled

Delayed script: Amoxicillin / clarithromycin/ Doxycycline
Deny allergy
Salbutamol as required

STREP THROAT Clarithro
Clarithromycin deny allergy
Calpol / otc neurofen if required
Difflam / deny asthma
Dioralyte if required
TCB as required
Urgent attention
if any acute deterioration
(ooh 111 / a+e )
Review if not settled
Safety net advise
Meningitis / Scarlet fever
Dehydration

STREP THROAT pen v
Penicillin v deny allergy
Calpol / otc neurofen if required
Difflam / deny asthma
Dioralyte if required
TCB as required
Urgent attention
if any acute deterioration
(ooh 111 / a+e )
Review if not settled
Safety net advise
Meningitis / Scarlet fever
Dehydration

EAR TREATMENT :
Keep ears dry
Abx oral: Clarithromycin
Ear med: otomize
Deny allergy:
Urgent attention if any acute deterioration
TCB / Review if not settled

EAR TREATMENT :
Keep ears dry
Abx oral: Amoxicillin
Ear med: otomize
Deny allergy:
Urgent attention if any acute deterioration
TCB / Review with own GP if not settled

EAR TREATMENT :
Keep ears dry
Abx oral: Clarithromycin
Ear med: otomize
Deny allergy:
Urgent attention if any acute deterioration
TCB / Review if not settled

UROLOGY: male

Suspected UTI
Dysuria and frequency
last few days,
Fevers: nill ? on/ off
No renal angle pains
No loin to groin pains
No haematuria

UROLOGY: female

Suspected UTI
Dysuria and frequency
last few days,
Fevers: nill ? on/ off
No renal angle pains
No loin to groin pains
No haematuria
Vaginal symptoms: Nill
lmp:

Abx issued: Nitrofurantoin,
no allergies.
egfr satisfactory
Stop after 3 days if settled
Urine for mc+s if not settling after 3 days
TCB as required
Urgent attention if any acute deterioration
(ooh 111 / a+e )
Review if not settled
Safety net advise pyelonephritis

Abx issued: Trimethoprim,
no allergies.
Stop after 3 days if settled
Urine for mc+s if not settling after 3 days
TCB as required
Urgent attention if any acute deterioration
(ooh 111 / a+e )
Review if not settled
Safety net advise pyelonephritis

EXAM PEAD QUICK
Appears Stable Alert
No meningism /
Brudzinski negative
t:
p:
hs: normal
rr:
wheeze: nill
crackles: nill
Abdo: snt
Ears: nad
Throat: nad
Lymphadenopathy: nill
Rashes: nill

Face 2 Face Safety net
Urgent attention if any acute deterioration
TCB / Review with own GP if not settled

Face 2 Face Safety net
Urgent attention if any acute deterioration
(ooh 111 / a+e )
TCB / Review with own GP if not settled

Face 2 Face Safety net
Urgent attention if any acute deterioration
TCB / Review with own GP
With full access to
notes test results and specialist letters

Face 2 Face Safety net
Urgent attention if any acute deterioration
(ooh 111 / a+e )
TCB / Review with own GP
With full access to
notes test results and Specialist letters

Safety net advice:
Meningitis / scarlet fever
Discussed signs of dehydration

Safety net advice:
Meningitis / scarlet fever
Discussed signs of
respiratory distress

COUGHS AND COLDS

STREP THROAT Amox
Amoxicillin deny allergy
Declined pen v (? taste issues)
Calpol / otc neurofen if required
Difflam / deny asthma
Dioralyte if required
TCB as required
Urgent attention
if any acute deterioration
(ooh 111 / a+e )
Review if not settled
Safety net advise
Meningitis / Scarlet fever
Dehydration

11	12	13	14	15	16
132	144	156	168	180	192

Face 2 Face Safety net
Urgent attention if any acute deterioration
TCB if not settled

Face 2 Face Safety net
Urgent attention if any acute deterioration
(Here / ooh 111 / a+e )
TCB if not settled/settling

Face 2 Face Safety net / test results
Urgent attention if any acute deterioration
Review with own GP with test results
Sooner if required
tcb alliance (may not get test results)

Face 2 Face Safety net / test results
Urgent attention if any acute deterioration
(Here / ooh 111 / a+e )
Review with test results
Sooner if required