The Magic of Christmas

‘The reading isn’t stable. You’re looking at artefact.’ Lara stroked a reassuring hand over the child’s head. ‘Try and keep still for me, sweetheart. There’s a good girl.’ She watched the number and then nodded. ‘Ninety per cent. We need to give her some oxygen. She’s tachycardic and pale and—’

‘That can happen with any infection.’ Penny washed her hands. ‘Her breathing actually seems quite relaxed.’

Relaxed?

Knowing that to argue with Penny would achieve nothing except to frighten the mother, Lara was frantically considering her options when Christian strode through the door.

‘You wanted me?’

‘Yes.’ Weak with relief, Lara reached for an oxygen mask. Christian would know what to do. ‘She’s pyrexial and she’s making virtually no respiratory effort. I’m just going to give her some high-flow oxygen.’

‘Good.’

‘With a mask?’ Penny frowned. ‘She might find it easier to tolerate a nasal cannula.’

‘Possibly, but the maximum flow rate is two litres a minute and she needs a higher concentration than that.’ Lara gently placed the mask over the child’s face. ‘Do you like dressing up, Amy? This mask is exactly like a dressing-up mask.’ She looked at Christian. ‘She’s been complaining of headache and abdominal pain.’

‘It’s highly probably that she has a GI infection and the headache is probably a result of dehydration,’ Penny said crisply, reaching for an IV tray. ‘A stomach bug

. My flatmate has had the same thing all week.’

‘That’s quite possible. Or the abdominal pain could be referred from the diaphragm.’ Lara held the mask in place and rubbed her finger gently against the child’s cheek. ‘You’re a good girl. Dr Blake is just going to listen to your chest and feel your tummy.’

‘Temperature?’

‘Thirty-eight point seven and she’s wheezing. She could be suffering from a lower respiratory tract infection.’

Penny looked at her. ‘Pneumonia is extremely unlikely if there’s wheeze present.’

‘Her ears and throat are clear.’ Christian examined the child’s chest. ‘Let’s get a line in and take some bloods. They may not be conclusive but they might provide a useful baseline. We’ll do the usual, plus CRP and ESR.’

The mother was white and upset. ‘She kept complaining of a headache. I thought that was because of the temperature.’

‘Mycoplasma?’ Lara gave a tiny shrug and Christian looked at her as he removed the stethoscope from his ears.

‘It’s possible.’ He tapped the child’s chest, listening for dullness to percussion or bronchial breathing. ‘There’s no sign of consolidation,’ he murmured, ‘but that doesn’t necessarily exclude pneumonia.’

‘She has a rash, Christian,’ Lara said quickly, noticing the red raised marks on the child’s body.

‘A rash?’ the mother whimpered. ‘Is it meningitis?’

Christian shook his head. ‘I don’t think that’s what we’re looking at here. Lara, give me a 22-gauge needle.’ He stroked his hand along the child’s arm, looking for a vein. ‘Squeeze for me.’

Lara closed her fingers round the child’s tiny wrist and Christian slid the needle into the vein with no apparent effort.

‘That’s quite a party trick,’ Lara said, handing him some adhesive tape then reaching for the blood bottles that she’d put ready. Their movements were smooth and synchronised. ‘Tell me what you want. FBC and cultures, obviously.’

He took the bottles from her and carefully withdrew the necessary blood. ‘Viral titres and mycoplasma antibodies. I think you might be right.’

Penny walked back into the room with the radiographer just as Lara was bandaging the child’s hand to a splint so that the cannula wouldn’t be accidentally dislodged.

Christian glanced at the monitor. ‘Her sats are still below ninety-two per cent. She’s exhausted and she’s going to need IV antibiotics so I’m going to call paediatric ICU.’

‘PICU?’ Penny looked startled and followed him out of the room, clearly to glean more information on why he was so concerned.

Lara made the child more comfortable and explained what was happening to the mother.

The anaesthetist and the paediatrician arrived together, examined the child and transferred her to PICU.