THE infection that killed Emerald toddler Ryan Saunders was the most extreme case a medical expert had ever seen.
Toowoomba pediatric consultant Dr Jeffrey Prebble told an inquest in Rockhampton yesterday when he sought more information on Group A streptococcus toxic shock syndrome, the fatal condition, there was no medical information available in textbooks.
"I have never seen a child with such a severe case in my experience," Dr Prebble said.
Following Ryan's death, Queensland Health must ensure all doctors have access to updated medical journals.
On the last day of the inquest, Dr Prebble said a lumbar puncture was appropriate if there was a suspicion of meningitis, Dr Peter Roper's diagnosis of meningitis was "reasonable", despite the rarity of the infection.
"It's easy for me to say in retrospect," he said.
"Dr Roper is an experienced doctor. It was clear to me they didn't think his (Ryan's) clinical presentation was indicative of a sepsis infection."
Pediatric cardiologist Dr Gavin Wheaton told the inquest he believed Ryan's symptoms warranted an immediate surgical consultation, and stronger pain medication such as morphine "would have been appropriate".
"I think that Ryan's symptoms were difficult to interpret, but I have no doubt his pain was extreme and that some form of analgesia ... should have been given earlier," he said.
Ryan's examination at the Emerald Hospital, Dr Wheaton said, was appropriate and some investigation into the child's condition had been made.
"My understanding is the major concern with the child was pain and they couldn't identify the cause of that pain so the transfer was most appropriate," he said.
Dr Wheaton said based on that level of concern, medical attention should have been given to Ryan during the night of September 24, 2007.
Considering a child patient to be "toxic" was a "subjective judgement", he said, and in his expert opinion, he did not like the term because of its potential ambiguity.
The findings of the inquest are expected to be released next week in Rockhampton.
The Morning Bulletin yesterday published an article regarding the Ryan Saunders inquest which requires clarification.
The article incorrectly said Queensland Health took measures to "ensure" future child deaths, and should have said "prevent".
We regret the error.
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