Cough and Cold: Fever, Sore Throat, Rhinorrhea Flashcards
Cough and Cold
Fever
What are the symptoms, definition and the cause of the fever?
Symptoms - headache, backache, malgia, arthralgia, somnolence, chills and rigors
Definition - temperature consistently over 38 c
Cause - infection
Cough and Cold
Fever
What is the major substance producing
an elevation of the thermoregulatory set‐point?
Prostaglandin E2, released by the hypothalamus
Cough and Cold
Fever
What ages may not mount an elevated
temperature in the presence of serious illness?
Children <3 months of age and older adults (≥65 years of age)
Cough and Cold
Fever - Febrile Seizure
Who and when febrile seizure happen?
When a young child has a fever above 38°C (not considered epilepsy)
Most children outgrow having febrile seizures by the time they are 5 years old
Cough and Cold
Fever - Febrile Seizure
What are the causes?
Unknown?
Some evidence suggests that they’re linked to some viruses and the way that a child’s developing brain reacts to high fevers
Cough and Cold
Fever - Febrile Seizure
What are the presentations?
- Few minutes up to 15 minutes
- Convulse, shake, and twitch all over
- Roll the eyes
- Moan
- Become unconscious (pass out)
- Vomit or urinate (pee) during the convulsion
Cough and Cold
Fever - Febrile Seizure
How to manage?
◦ Treating child with fever medication will NOT
prevent or shorten a febrile seizure
◦ Acetaminophen, ibuprofen to keep child
comfortable a seizure or shorten it’s duration
◦ Gently place your child on the floor or the ground
◦ Remove any nearby objects
◦ Place child on his or her side to prevent choking
◦ Loosen any clothing around the head and neck.
◦ Watch for signs of breathing problems, including
bluish color in the face.
◦ Try to keep track of how long the seizure lasts
◦ Call paediatrician or family doctor for follow‐up
Cough and Cold
Fever - Febrile Seizure
When to call 911?
If the seizure lasts more than 3 minutes, or child
turns blue, more than one seizure in 24 hrs
Cough and Cold
Fever Meaurement
What are the anatomic sites to measure fevers?
Oral, rectal, axillary, temporal artery, tympanic membrane and transcutaneous routes all approximate
temperature
Cough and Cold
Fever Measurement
What is the gold standard for Children ≤ 5 years of age?
rectal thermometry
BUT can use other methods:
- Tympanic temperature measurement in children ≥2
years of age and axillary temperature measurement
in children of all ages
Cough and Cold
Fever Measurement
What is recommended for Children >5 years of age and adults?
oral thermometry
Cough and Cold
Fever Assessment Red Flags:
In a patient presenting with fever, what are the red flags for referring patient to the emergency immediately?
- age < 3 months
- presence of stiff neck, seizure, localized pain,
redness, swelling or heat - new wheeze/cough
- recent cancer therapy, e.g., chemotherapy
- In children, appearing very ill, excessively fussy,
irritable, crying inconsolably or other symptom(s)
worrying the patient
Cough and Cold
Fever Assessment Red Flags:
Additional red flags to assess?
refer for immediate examination by physician/urgent care
see chart for more
- age < 6 months
- fever > 40.5 C
- persistent wheeze/cough
- new onset rash and fever
- difficult to rouse, confused or delirious
- presence of serious underlying illness
- recent surgery or dental procedure
- recent travel
- recent consumption of raw or undercooked meat or fish
- recent initiation of new medication
Cough and Cold
Fever
Non-pharm management
- removal of excess clothing, bedding, increase fluid intake
- ambient temp set at 20-21 C, avoidance of physical exertion
- heating pad for earache, cold drink for sore throat
Cough and Cold
Fever
Pharm management
Antipyretics decrease prostaglandin synthesis in the brain and reducing the thermoregulatory set‐point
Acetaminophen, ASA, ibuprofen and naproxen sodium
◦ No naproxen or ASA in children!
◦ Short term use and administered at regular intervals
◦ Insufficient evidence for alternating acetaminophen and ibuprofen administration to reduce fever
