Isolated angioedema should prompt consideration of hereditary angioedema. Cold urticaria and dermographism are the most common inducible urticarias. Chronic spontaneous urticaria is autoimmune in origin, in approximately 40% of older children. Chronic urticaria is divided into chronic spontaneous urticaria and the inducible urticarias. Further investigations are usually unnecessary. The diagnosis is usually made clinically, and a focused history is vital. This review covers urticaria subtypes, diagnosis and treatment options for children. Episodes are usually acute, often triggered by viral infections ± antibiotics, with approximately a third progressing to chronic or recurrent urticaria. It is characterised by the sudden onset of wheals, angioedema, or both. Urticaria is common in childhood, affecting up to 15% of British children. The author would like to thank Mr John Stickley of Cardiac Services, Birmingham Children's Hospital, for his help with electronic delivery of the ECGs. The P waves may be subtle, at times hidden within the T wave, and the Acknowledgement The clue here is in the observation of P waves as markers of atrial activity and their relationship to the QRS complexes as markers of ventricular activity. We can think of these as abnormally fast or slow rhythms. Abnormalities of rhythm and conduction on the other hand, are more often associated with an acute presentation. The preceding abnormalities are usually encountered in elective situations, for example in a clinic. Quick look abnormalities (‘low hanging fruit’) The following sequence is recommended:Ĭardiac intervals and durations: PR, QRS, ST, QT Important abnormalities are less likely to be missed and over time practice makes interpretation an effortless and efficient exercise. Whilst there is no single ideal way to examine and interpret an ECG it is important to be methodical. This is reflected in right ventricular (RV) dominance in the newborn. There is low systemic vascular resistance by virtue of the placental circulation. Intrauterine pulmonary vascular resistance is correspondingly high. In utero our lungs are filled with amniotic fluid and do not participate in gas exchange. This is particularly evident in the newborn. The major element which distinguishes paediatric ECG variation in children compared to adults is the dimension of age, rather than size. The amplitude of the deflection is proportional to the voltage detected, which in turn reflects the mass of myocardium undergoing depolarisation and Remember how the ECG changes with age Conversely, myocardial depolarisation away from the electrode results in a downward deflection. In brief, myocardial depolarisation towards a positive ECG electrode results in a positive (upward) deflection. The ECG can be used in practice without an understanding of the underlying physics or physiology, but a basic appreciation of this does help. Knowledge of background co-morbidities is essential to drawing the correct conclusions from the information delivered by the ECG. Concurrent medication and electrolyte disturbances can have a significant effect. The first question to be answered is why the ECG has been requested. The ECG must always be interpreted within its clinical context.
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