Febrile

Question 1

Febrile - definition

Answer 1

Single temp 38.5+ C or sustained temp > 38.0 C for >1 hr.

Question 2

Causes

Answer 2

• UTI
• URTIs or pneumonia
• Meningococcal disease and bacterial meningitis
• Herpes simplex
• Kawasaki disease

Question 3

Red flags

Answer 3

1. High level of parental concern
2. Re-presentation within 48hrs
3. Clinical deterioration despite treatment
4. Recent surgery or burns

Question 4

High-risk patients

Answer 4

1. Neonates
2. Immunocompromised/neutropenic
3. Invasive devices (e.g. CVC)
4. ATSI

Question 5

Sepsis - signs and symptoms

Answer 5

1. Shivering/feeling cold, fever or hypothermia
2. Extreme muscle pain or discomfort
3. Pallor, discolouration or poor peripheral perfusion
4. Sleepiness, slurred speech, lethargy, floppiness.
5. Instinctive sense of being seriously unwell
6. SOB, tachypnoea/dyspnoea

Other - oliguria, hypotension, hypoglycaemia, metabolic acidosis (elevated lactate).

Question 6

Cold vs warm shock

Answer 6

Cold - narrow pulse pressure and prolonged CRT
Warm - wide pulse pressure, bounding pulses, flushed skin and rapid CRT.

Question 7

Sepsis protocol

Answer 7

0-5min - early detection, involve senior clinician, cardio-respiratory monitoring, assess airway and breathing, O2T as req.
5-15min - venous access, blood samples (culture, VBG, lactate/glucose, FBE, CRP, UEC, LFT and coag), IV ABs.
15-30min: IV fluid resuscitation + additional boluses (max 40ml/kg) , monitor for fluid overload.
30-60min: inotropes/vasopressors if persistent circulatory failure (after max IV boluses), involve critical care.
* Consider urinalysis and LP once stable.

Question 8

Neutropenia - protocol

Answer 8

Unstable or signs of sepsis - commence IV ABs, fluid resuscitation and blood sampling WITHIN 30MIN of arrival.

Stable - commence IV ABs (+/- fluid resuscitation) and blood sampling WITHIN 60MIN of arrival.

Question 9

Neutropenia - definition

Answer 9

Neutrophil count < 500/mm(3)
Suspected - recurrent neutropenia OR oncology patient with oral/IV chemo in past 14 days.

Question 10

Febrile seizures

Answer 10

Benign, common between 6months-6yrs.
Simple - generalised tonic-clonic, duration < 15 min, complete recovery within 60 min, nil recurrence.
Complex - focal features, duration > 15min, incomplete recovery, recurrence within same febrile illness.

Question 11

Meningitis - definition

Answer 11

Inflammation of the meninges surrounding the brain and spinal cord due to bacterial (MEDICAL EMERGENCY) or viral infection.

Question 12

Encephalitis - definition

Answer 12

Inflammation of the brain parenchyma.

Question 13

Meningitis - signs and symptoms

Answer 13

1. Fever
2. Purpuric rash (non-blanching)
3. Seizures
4. ALOC - irritability, drowsiness.
5. Nausea, vomiting or diarrhoea (or poor feeding in infants)
6. Pain - headache, neck stiffness, photophobia.

Question 14

Meningitis - treatment

Answer 14

1. Investigations - blood samples (panels & cultures), LP and imaging (encephalitis, focal symptoms or signs of RICP)
2. Isolation - droplet precautions for first 24hrs.
3. ABs - administered WITHIN 30MIN of decision to treat.
4. Seizure protocol
5. Fluid restriction