Normal observations don’t always mean a stable patient. In early shock (especially haemorrhagic or septic), patients can maintain normal BP and HR due to compensatory vasoconstriction and catecholamine release. 👉 Look for trends, not single numbers 👉 Pay attention to mental state, skin perfusion, capillary refill, and urine output 👉 A “normal” BP can still hide significant hypoperfusion By the time hypotension shows up, the patient may already be in trouble. What subtle sign has saved you from missing a sick patient recently? 👇

You don’t need to sound overly confident with patients what you need is to be clear. Much of patient anxiety doesn’t come from the diagnosis itself, but from uncertainty about what happens next, what’s being ruled out, and how decisions are made. When things aren’t definitive (which is often), it’s entirely appropriate to say: “This is what we know so far, this is what we’re considering, and this is our next step.” This approach does three important things: - It normalises clinical uncertainty without undermining competence - It helps patients understand the reasoning behind decisions - It increases trust, engagement, and adherence to the plan Patients rarely expect certainty. They expect transparency and direction. A small communication shift, but one that consistently improves consultations and outcomes.

For localised, non-bullous impetigo, CKS recommends hydrogen peroxide 1% (Crystacide) as first line. 🔍 When Crystacide is enough: Mild, localised impetigo Few lesions Child otherwise well No systemic symptoms 🧼 Management basics: Gentle crust removal (warm water) Apply Crystacide 2–3 times daily for 5 days Good hand hygiene Avoid sharing towels or flannels 💊 Reserve topical or oral antibiotics for: Extensive or spreading disease Bullous impetigo Systemic symptoms Treatment failure High-risk children 💡 Why this matters: Reduces antibiotic resistance Aligns with NICE and CKS guidance Simple, effective, and parent-friendly Sometimes less really is more. 👉 Are parents receptive when you suggest Crystacide instead of antibiotics? For me the first few were after that most parents were easy. Using the term antimicrobial cream helps!

Red, sticky eyes in kids ≠ automatic antibiotics. Most cases are viral or allergic, and will settle with: Good eye hygiene Lubricating drops Time (the most underrated treatment) 🔍 When to pause before prescribing: Mild redness Watery or mucoid discharge Bilateral symptoms Child otherwise well 💊 Antibiotics are more useful when: Thick, purulent discharge Lids stuck shut on waking Marked conjunctival redness Unilateral symptoms that persist 💡 Why this matters: Reduces unnecessary antibiotic use Avoids resistance Saves families stress + pharmacy runs Sometimes the best medicine is reassurance and safety-netting. 👉 What’s your go-to advice for parents with red eyes?

Key point: Most phimosis in young boys is physiological and settles with time. Reassure first 🧘‍♀️ 🚫 Do NOT refer if: Child is asymptomatic No infections, pain, or urinary problems Non-retractile foreskin in boys <10–11 years (normal development) 🧴 Try in primary care first if symptomatic: Topical steroid (e.g. betamethasone 0.05%) Apply 1–2× daily for 4–6 weeks Gentle retraction only (no force!) 📨 Refer to paediatrics / paediatric urology if: Pathological phimosis suspected (e.g. scarring, white fibrotic ring, BXO) Recurrent balanitis/balanoposthitis Recurrent UTIs linked to foreskin issues Urinary obstruction (weak stream, ballooning with symptoms) Failure of topical steroids Painful erections in older children/adolescents 🚨 Same-day urgent referral: Paraphimosis Acute urinary retention ✨ Bottom line: Reassure → steroid trial → refer only if red flags or treatment failure.