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Paediatrics > 1: Immunology - Fever in under 5's > Flashcards

1: Immunology - Fever in under 5's Flashcards

1
Q

How should children under-5 with a fever first be assessed

A

Using the traffic light system to determine severity

Unless sepsis then activate sepsis protocol

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2
Q

What is a mnemonic to remember categories for Fever in under 5’s

A

CARHO

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3
Q

What are the 5 categories looked at in traffic light system

A

Colour

Activity

Respiration

Circulation and hydration

Other

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4
Q

What is ‘low-risk’ (green) for colour

A

Normal

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5
Q

What are 4 points ‘low-risk’ (green) for activity

A
  • Smiles
  • Stays awake
  • Opens eyes
  • Strong cry
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6
Q

What is one point for circulation and hydration in green ‘ low-risk’

A

Moist mucous membranes

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7
Q

What is other in ‘low-risk’ green

A

No red or amber features

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8
Q

How will a medium-risk (amber) child’s colour present

A

Pale

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9
Q

Describe 4 features of activity in a medium-risk child

A
  • No smile
  • No response to social cues
  • Only stays awake with prolonged stimulation
  • Decreased activity
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10
Q

Describe clinical features of respiration in a medium-risk (amber) child

A
  • Nasal flaring
  • Crackles
  • Tachypnoea
  • Decrease SpO2
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11
Q

How will RR present in medium-risk child who is 6-12 months

A

> 50

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12
Q

How will RR present in medium-risk child who is older than 12-months

A

> 40

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13
Q

How will SpO2 present in a child who is medium-risk

A

< 95%

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14
Q

What are 4 features of circulation in a medium-risk child

A
  • Prolonged cap refill
  • Poor Feeding
  • Decrease Urine Output
  • Dry mucous membranes
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15
Q

How will HR present if less than 12-months in medium-risk child

A

> 160

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16
Q

How will HR present if less than 12-24months in medium-risk child

A

> 150

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17
Q

How will HR present if 2-5 years in medium-risk child

A

> 140

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18
Q

What are 5 other features in a medium-risk child

A
  • Fever >39 if 3-6 months
  • Fever >5 days
  • Rigors
  • Swollen joint
  • Not weight bearing
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19
Q

How will colour appear in high-risk (red)

A

Pale, mottled

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20
Q

What are four features of activity in high-risk children

A
  • Decrease response to social cues
  • Does not wake
  • Looks ill to HCP
  • Continuous high- pitch cry
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21
Q

What are 3 features of respiration in high-risk children

A
  • Grunting
  • Chest indrawing
  • RR > 60
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22
Q

What is a feature of circulation in high-risk infants

A

Reduced skin turgor

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23
Q

What are 5 other features of fever in high-risk infants

A
  • Blueing fontanelle
  • Neck stiffness
  • Status epilepticus
  • Focal neurological signs
  • Focal seizures
  • Non-blanching rash
24
Q

What is first-line investigation for fever in under-5

A

Observations: HR, RR, T, Cap Refill

25
Q

If capillary refill is abnormal, what should be measured

A

BP

26
Q

How is temperature measured if child is under 4 weeks

A

Electrical thermometer in the armpit

27
Q

How is temperature measured if 4W - 5 years

A
  • Infrared tympanic thermometer
  • Chemdot
  • Electrical thermometer
28
Q

What category is a 3-6m with T > 39

A

Amber

29
Q

What category is a <3m with T > 38

A

Red

30
Q

If a remote assessment and child is life-threatening status what should be done

A

Call 999

31
Q

If a remote assessment and a child is red (high-risk) what is done

A

Urgent review by HCP in 2-hours

32
Q

If remote assessment and child is amber (medium-risk) what is done

A

Review by HCP - urgency decided by HCP

33
Q

If remote assessment and child is green (low-risk) what is done

A

Manage at home - with appropriate advice for patients

34
Q

If non paediatric HCP see’s as life-threatening patient, what should be done

A

Call 999

35
Q

If a non-paediatric HCP see’s a high-risk (red) infant what should be done

A

Refer to paediatric specialist

36
Q

If non-paediatric HCP see’s a amber child what should be done

A

Safety-net patients:

  • Arrange further follow-up
  • Liaise with other HCP to ensure child can be assessed out-of-hours
37
Q

If non-paediatric HCP see’s a green child what should be done

A

Manage at home

38
Q

If suspected pneumonia, but patient is not admitted to hospital, what should NOT be done

A

Do not do a CXR

39
Q

If suspect UTI and under 3-months what is done

A
  • Refer to paediatrics

- Urine collection

40
Q

If suspect UTI and 3-months to 3-years what is done

A
  • Urinalysis
41
Q

If suspect UTI and over 3-years what is done

A
  • Urinalysis
42
Q

Explain antibiotics in fever in child under 5 given by non-paediatric specialists

A

Do not give antibiotics if unable to identify source of fever

43
Q

If non-paediatric specialist suspects meningococcal disease, what should they give

A

Start IV (or IM) benzylpenicillin asap

44
Q

In a child under 3-months what investigations are performed by paediatric specialist

A
  • Obs: T, RR, HR
  • FBC, CRP, Blood Culture
  • Urinalysis
  • CXR
  • Stool Culture
45
Q

What are the two indications for lumbar puncture in children under 3-months

A
  • ALL children under 1-month

- 1-3 months with WCC <5 or >15

46
Q

In children older than 3-months with red-features what 4 investigations are ordered

A
  • FBC
  • CRP
  • Urine testing
  • Blood Culture
47
Q

In high-risk children older than 3-months what 4 investigations may be ordered

A
  • ABG
  • U+E
  • CXR
  • LP
48
Q

If children older than 3-moths with amber features what 3 investigations may be ordered

A
  • FBC
  • CRP
  • Urine testing
49
Q

When is LP indicated for amber children over-3

A

ALL children under 1-year

50
Q

When is CXR ordered for amber children over-3

A

WCC >20 and T > 39

51
Q

What investigations are indicated for low-risk children

A

Urine test

52
Q

If a children over-3 have fever, without identifiable cause, what is done

A

Admit to hospital for period observation

53
Q

If child is symptomatic with fever, what is first-line

A

Anti-pyretics (NSAIDs, Paracetamol)

54
Q

What are indications for antibiotics in children under 3-months with fever

A

ALL children under 3-months

Children 1-3 months with:

  • Fever
  • WBC <5 or >15
55
Q

What antibiotics are first-line for under 5’s with fever

A

Third generation cephalosporin

56
Q

In addition to cephalosporin, what else are children given and why

A

ampicillin or amoxicillin = antibiotics effective against listeria

Paediatrics (61 decks)

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