Questionnaire/history:

Acutely unwell?

Invasive meningococcal disease/acute sepsis?

Acute leukaemia?

Other cause?

Raised superior Vena Cava (SVC) pressure?

- Petechia usually around mouth and eyes?

- Recent cough or vomit?                                      

Idiopathic thrombocytopenic purpura (ITP)?

Haemophilia?

Vitamin deficiency?

- B12, folate deficiency (?pancytopenia))?

- Vit. C deficiency (?collagen defect)?

Vasculitis?

Senile purpura?

- > 70 years?

- Skin fragility?

Drugs?- Cotrimoxazole?

- Quinine?

- Carbamazepine?

- Valproate?

- Antiplatelets?

- Anticoagulants?

- Steroids in older patients?

None-accidental injury (NAI)?

- Ears?

- Face?

- Trunk?

- SVC area (?strangulation)?

Past medical history?

Current medication?

Known drug allergies:

Examination:

Petechiae (1-2 mm diameter)?

Purpura (> 2 mm)?

Investigations:

Full blood cell count (FBC)?

Coagulation screen?

Management:

Meningococcal sepsis excluded?

Severe thrombocytopenia excluded?

Discussed with on-call paediatrician or haematologist regarding admission?

Resource(s):

BMJ 2016