06 - Fever

Question 1

Septic screen

Answer 1

Bloods
urine output 
fluid 
antibiotics 
lactate (ABG) 
Oxygen

Question 2

Some high risk sx in children fever

Name 3

Answer 2

pale/mottled/ashen/blue skin, lips or tongue
no response to social cues[3]
appearing ill to a healthcare professional
does not wake or if roused does not stay awake
weak, high-pitched or continuous cry
grunting
respiratory rate greater than 60 breaths per minute
moderate or severe chest indrawing
reduced skin turgor
bulging fontanelle.

Question 3

Intermediate risk sx in children

Name 3

Answer 3

pallor of skin, lips or tongue reported by parent or carer
not responding normally to social cues[3]
no smile
wakes only with prolonged stimulation
decreased activity
nasal flaring
dry mucous membranes
poor feeding in infants
reduced urine output
rigors.

Question 4

None infective causes of fever

Name 3

Answer 4

Immune diseases (SLE, sarcoid, Kawasaki, IBD,), Iatrogenic (neuroleptic malignant, blood transfusion reactions, anaesthetics, aspirin, infected lines), cancers, gout, crush syndrome,

Question 5

What is SIRS ?

Answer 5

Severe inflammatory response syndrome

2 / more of 
HR >90
temp >38 
RR >20 
WCC <4 or >12

Question 6

Abx for various septic shocks 
Community aquire pneumonia 
Abdo 
Menigeal 
Skin 
Urinary

Answer 6

CAP = Co-amox + clarithromycin, 
Abdo = gent and met, 
Menigeal = Ceftriaxone
Skin: Fluclox
Urinary: Cef + gent

Question 7

what is CRB65 and for?

When do you also check Blood urea nitrogen

Answer 7

severity of CA pneumonia

Confusion, resp >30, BP<90, Age >65
Score of 2 or more = admit

Hospital acquired pneumonia

Question 8

Mx of every inpatient with penumonia

Answer 8

Abx and CXR within 4 hours

FBC, culture, sputum culture
consider testing for legionella

Question 9

Mx of CAP

Answer 9

Amox 5 days

Add a macrolide if severe (eg clarithromycin)

Question 10

How long post admission of Sx development for HAP

Answer 10

48 hours or more

Question 11

What is malignant hyperpyrexia ?
What happens ?

Mx?

Answer 11

Reaction to general anaesthetic, usually volatile agents.
Produce increase in oxidative metabolism of skeletal muscle.
Homeostasis is overwhelmed: hypoxia, hyperthermia and hypercapnia
Tachycardia, rhabdomyolysis, acidosis, death,

Remove trigger and give dantrolene (a muscle relaxant) + supportive measures.