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Emergency Medicine > Febrile Child > Flashcards

Febrile Child Flashcards

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1
Q

What is the most common childhood CC?

in acute care

A

Febrile child

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2
Q

Fever is defined as >_____F or _____C

A

100.4F or 38C

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3
Q

The biggest concern of a febrile baby is ____

A

invasive bacterial infection (IBI) formerly referred to as Serious Bacterial Infection (SBI)

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4
Q

Benefits of having a fever

A

inhibits growth of viruses and bacteria

controlled by the CNS

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5
Q

In children, what is the standard method to take temp?

A

rectal

Oral is okay if they cooperate
Axillary is usu lower than actual (no conversion equation)
infared is sufficient

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6
Q

Bacterial meningitis is MC in what part of your life?

A

within 1st mo of life

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7
Q

a baby is sick within 7 days of life. How did they most likely get it?

A

vertical transmission from parents
Can be from community or hospital acquired tho

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8
Q

5-10% of neonates with early onset Group B sepsis (GBS) have concurrent ______

A

meningitis

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9
Q

Kids with meningitis may present with _____

A

seizures (20-50%)

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10
Q

Decreased oral intake and acute change in sleep patterns can be clues to _____

A

invasive infection

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11
Q

Uncircumcised baby presents with FTT, jaundice, and vomiting. What is the most likely Dx?

A

UTI

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12
Q

a wheezing child most likely has what infx?

A

viral bronchiolitis

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13
Q

Your preceptor tells you to check for signs of meningitis in a febrile baby. It can fully flex its head and has an unremarkable Hx. Can you rule out meningitis?

A

No, neonates with meningitis can present with full neck flexion and unremarkable history, so always maintain high index of suspicion

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14
Q

No focal source is found in febrile baby <28 days. What should you order?

A
  • Urinalysis and urine culture
  • CBC
  • Procalcitonin or CRP
  • Blood Culture
  • Lumbar Puncture, run CSF and culture

Lumbar puncture is to be done in all children <28 days
Low glucose and elevated WBC (pleocytosis) is indicative of infection
Run PCR to test for HSV

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15
Q

What labs do you order for the CSF after doing a lumbar puncture on a baby?

A
  • Low glucose and elevated WBC (pleocytosis) is indicative of infx
  • PCR test for HSV
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16
Q

What type of rash does meningitis cause

A

Petechial rash

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17
Q

Admit a pt for at least ____hrs on empiric ABX

A

24-36

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18
Q

2 MC pathogens you absolutely need to cover with ABX

A

GBS (Group B Strep)
Listeria
E coli
most S pneumonia
N meningitides

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19
Q

Empiric ABX for febrile child

A

ampicillin and gentamicin
or
ampicillin and cefotaxime

20
Q

If febrile neonate is still ill-appearing after empiric ABX, add on ______

A

Acyclovir

21
Q

When can you discharge a recovering febrile neonate

A

if cultures and WU are (-)

22
Q

What CANT neonates get ceftriaxone?

A

biliary sludging -> kernicterus

23
Q

Age range for young infant

A

28-60 days

24
Q

MC cause of unexplained fever and bactermia in young infants & those 3mo-3yo

A

UTI

UTI and Bronchiolitis can occur at same time

25
Q

are young infants at higher risk for IBI if they have a confirmed viral infx?

Invasive Bacterial Infection (IBI)

A

NO
Infants 3 months or younger with confirmed viral infection are at lower risk of IBI when compared to kid with no identified virus

26
Q

Have high concern for septic shock if young infant presents with HR > ____ and RR > _____

A

HR > 160
RR > 60

27
Q

does bacterial meningitis show more SS in neonates or young infants?

A

neonates

28
Q

is a bulging fontanelle an early or late sign of a febrile young infant with poss meningitis

A

LATE

29
Q

The labs for a febrile neonate and young infant are the same except that you only do a lumbar puncture on a young infant if….

A

there is more than one inflammatory marker elevated

30
Q

Trmnt for febrile young infant

A
  • Treat focal source of infx
  • ONLY US (+) -> discharge home on ABX (Cefuroxime)
  • ONLY CBC (+) -> consider discharge home on ABX
  • Well-appearing infants over 28 days old can be given single IM dose of ceftriaxone and encouraged to have 24 hour follow-up
  • If deciding to admit a patient, begin on empiric antibiotics and observe 24-36 hours, and discharge home if culture results are negative.
31
Q

Febrile child 3mo - 3yo

MC pathogens of bacterimia in this age group

A
  1. Steptococcus pneumonia
  2. H. flu type B (prior to vacc)
32
Q

Febrile child 3mo - 3yo

most common bacteria causing UTI

A

E. coli

33
Q

MC bacteria causing blood stream infx

A

Staph aureus (15%)

associated with skin, soft tissue, or msk infx

34
Q

Febrile child 3mo - 3yo

Initial order for WU of fever and bacteremia with unknown ET

A

Urine Analysis
(+) -> urine and blood cultures

35
Q

Febrile 3mo - 3yo

Lab findings suggestive of serious bacterial infx

A
  • UA with WBCs, bacteria, or positive leukocyte esterase and nitrite findings
  • WBC >15K
  • Absolute Neutrophil Count (ANC) >10K
  • CRP >40mg/L
  • Procalcitonin > 0.5ng/mL
36
Q

Pts are demanding ABX for their non-toxic 1yo. Wdyd?

A

stand your ground and explain that empiric ABX is not reccommended for children 3mo - 3yo

37
Q

Fever of unknown origin (FUO) is defined as a fever >______C (_____F) at least once per day for ____ days with no apparent Dx after initial outpt or hospital eval.

A

38.3C (101F)
8+ days

38
Q

Most common infections that initially present as fever of unknown origin

A

Bartonellosis
UTI

Others: bacterial, fungal, viral

39
Q

MC inflammatory diseases that initially present as fever of unknwon origin

A

juvenille idiopathic arthritis
SLE

40
Q

MC malignancies that initially present as fever of unknwon origin

A

leukemia
lymphoma

41
Q

PE of pt with fever of uknown origin should focus on which body parts?

A

skin, lymph nodes
liver, spleen
eyes

42
Q

fever of unknown origin

lab orders

A
  • CBC with peripheral smear
  • CMP
  • CRP
  • ESR
  • Urinalysis and blood culture
  • HIV serology
  • Hepatitis A and B serology
  • Tuberculosis screening tests or interferon gamma release assays
  • Throat culture
  • CMV, EBV testing
  • ANA
  • RF
  • Ferritin
  • Complement proteins
43
Q

fever of uknown origin

Imaging/study orders

A

Chest X-ray
ECHOcardiography
CT chest
CT head→ MRI
CT abdomen/pelvis
PET Scan
Endoscopy

44
Q

4yo child presents with:
* Fever>5 days
* Bilateral conjunctivitis
* Oral mucosal change (strawberry tongue)
* Extremity changes
* Cervical Lymphadenopathy
* Diffuse non-specific rash

What infx is this most likely? why is it VITAL that you dont miss this Dx in children under 5yo

A

Kawasaki disease

Kids get really sick, can develop heart disease due to vasculitis associated with coronary arteries, sometimes requiring heart transplants

45
Q

Treat a fever with _____

A

Antipyretics
* Acetaminophen:10-15mg/kg every 4-6 hours
* Ibuprofen: 10mg/kg every 4-6 hours (not indicated in children under 6 months old

Pyretic = Feverish
Antipyretics cause the hypothalamus to override a prostaglandin-induced increase in temperature. The body then works to lower the temperature, which results in a reduction in fever

46
Q

Which age grp of febrile children ALWAYS get a lumbar puncture to eval for meningitis

A

Neonates

Emergency Medicine (11 decks)

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