approach of a febrile child Flashcards
how do we measure fever inn children below the age of 4 week s?
electronic thermometer in axilla
how is fever measures in children within the 4 weeks to 5 years range ?
electronic thermometer
chemical dot thermometer
infrared tympanic
what is the causative organism inn occult bacteremia ?
stept pneumonia
what is the presentation of meningococcemia ?
non blanching rash
signs of meningitis
DIC
use glass/tumbler test
what is the presentation for kawasaki disease ?
fever more than 5 days bilateral conjunctival injection strawberry tongue red swollen mucous membranes desquamation of the fingers polymorphous rash
what is a common complication of kawasaki disease ?
coronary artery aneurysm
what is the treatment for kawasaki disease ?
aspirin
IVIG
what is the differential diagnosis of strawberry tongue ?
scarlet fever
kawasaki disease
what is the nature of the rash associated with chicken poc ?
vesicles and pustules
pleomorphic rash
central to peripheral
what is the presentation of chicken pox?
fever but not high in grade
rash comes after the fever
when is chickenpox infectious ?
1-2 days before the appearance of the rash up until the last crusty vesicle
what is the presentation of measles ?
3Cs in prodrome very infectious very high grade fever, bad general condition descending rash koplik spots rash appears at the end of the fever
what is the presentation of scarlet fever ?
strep tonsilitis
strawberry tongue
sand paper rash
what is the presentation of roseola infantum ?
baby measles
similar in presentation to measles but a good general condition
rash appears after fever ( low grade)
what is slapped cheek disease ?
fifth disease / erythema infectiosum
cause by parvovirus B19
ages 4-10 years
what is the presentation of erythema infectiosum ?
bright red lacy rash on the cheeks appears after the improvement of cold like symptoms
what is the traffic light system ?
used to classify patients according to fever
green
amber
red
what are the features of red stage in the traffic light system ?
chest indrawing grunting status epilepticus decreased skin turgor bile stained vomit RR more than 60 fever above 38 in 0-3 months old fever above 39 in 3-6 months old weak, high pitched or continuous crying
how is a rash described ?
SCALDA Size colour arrangement lesion morph distribution ask about hair and nails and check between the fingers
what is the presentation of tonsillitis ?
fever chills headache abdominal pain GI disturbances exudate palatine petechiae
what is the causative organism in tonsilitis ?
group a beta hemolytic strp
EBV
treat with penicillin
when should a LP be considered in a feverish child ?
in all children under the red label
under one year of age if amber
how often should children in red or amber be reassessed ?
reassess in 1-2 hours
what are the investigations for a feverish child ?
WCC
CRP
Procalcitonin
chest x ray
when should immediate parenteral AB be administered ?
shocked level
unrousable
showing signs of meningococcemia
reduced consciousness or seizures
all infants younger than 1 month
all infants between 1-3 who appear unwell
all 1-3 months who have a WCC less than 5000 or more than 15000
what are the antipyretic interventions ?
tepid sponging
no over or under dressing
paracetamol and ibuprofen interchangeably
does not prevent febrile seizures
