Febrile Child Flashcards
Define fever in a child
Temperature >38C
What is the gold standard for measuring temperature?
What type of thermometer should be used in a child <3 months old?
Gold standard= axilla or tympanic
In a child under 3 months use axilla only
How is the height of fever related to severity in a child?
Not related, a child can have a high fever in less severe disease
What are the normal ranges for Systolic BP, HR, RR in a newborn?
Systolic BP: 60-105
Heart rate: 110-170
Resp rate: 25-60
What are the normal ranges for systolic BP, HR and RR in a 3-6 month old?
Systolic BP: 65-115
HR: 105-165
RR: 25-55
What are the normal ranges for systolic BP, HR and RR in a 1-4 year old?
Systolic BP: 70-120
HR: 85-150
RR: 20-40
What are the normal ranges for systolic BP, HR and RR in a 6-10 year old?
Systolic BP: 80-130
HR: 70-135
RR: 16-34
What are the normal ranges for systolic BP, HR and RR in a 12-17 year old?
Systolic BP: 90-140
HR: 60-120
RR: 14-26
What do the following terms mean in Paediatrics?:
Irritable
Miserable
Lethargic
Non-blanching rash
High pitched cry
Irritable: meningeal irritation/sepsis- always escalate
Miserable: grumpy/febrile
Lethargic: sleepy/floppy (head flops back when lifted up)- escalate
Non-blanching rash: several causes but always assume meningococcal infection and escalate
High pitched cry: indicative of unwell child- escalate
What questions should be asked in the history (from both parents and child)?
- Normally fit and well?
- Hospital admissions
- Past diagnoses
- Current medications
- Allergies
- Gestation at birth- NICU? Premature babies vulnerable to chest infections and bronchiolitis
- Immunisation status
- Concerns with growth or development?- concerns with failure to thrive/abnormal weight loss
- Red flags
What possible red flags could be noted in a paediatric examination?
- Reduced GCS
- Appears unwell
- Sunken eyes
- Reduced skin turgor
- Raised HR and RR
- Reduced urine output
- Normal/prolonged CRT
- Reduced blood pressure- sign of peri arrest
Describe the head to toe examination of a child
- End of bed assessment
- Awake/asleep/lethargic
- Tone
- Colour
- Skin-obvious rashes
- Playing?
- Head to toe examination
- Face- eyes, lips, tongue
- Fontanelle
- Listen to chest- listen to top and bases, heart sounds
- Feel and listen to abdomen
- Check nappy
- Hands- rashes, palms, colour, perfusion/capillary refill
- Legs- mottled
- Toes
Name 3 common causes of viral fever in children
- URTI
- LRTI
- Gastroenteritis
Name some common bacterial causes of fever in children
- LRTI
- Otitis media
- UTI
- Septic arthritis
- Sepsis
- Meningitis
- Collections/abscesses
Name the common non-infective causes of fever in a child
- Post immunisation (esp meningitis B)
- Kawasaki
- Autoimmune (e.g. JIV, IBD)
Describe the common causes (mild, mod and severe), investigations and management of viral infections
Causes:
- Mild: rhinovirus
- Moderate: varicella, adenovirus
- Severe: influenza, HSV, measles
Investigations:
- Samples: stool, sputum, skin
- Bloods
- LP
Management:
- Supportive care: IV fluids, antipyretics
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What are the possible severe complications of varicella infection?
Encephalitis/meningitis
Group A streptococcal infection (through skin lesions)
Describe the clinical presentation, investigations and examination findings and management of pneumonia in children
- Clinically:
- Tachypnoea
- Crackles on chest- scattered crackles tend to be viral
- Nasal flaring
- Recessions
- Cyanosis
- Sats <94%
- Causes:
- Strep pneumoniae- generally in younger children
- Mycoplasma pneumoniae- generally in older children
- Staph aureus- tend to get more cavitations
- Comorbidities increase risk (cardiac/respiratory patients, prematurity)
- Investigations:
- CXR
- Bloods
- NPA: viruses
- Sputum: bacteria
- Management:
- Antibiotics
- Oxygen PRN
- Fluids PO
- Monitor for complications
Describe the clinical presentation, investigations and examination findings and management of UTIs in children
- Clinically:
- Vomiting
- Poor feeding
- Abdo pain
- Urinary frequency/dysuria
- Causes:
- E Coli
- Klebsiella
- Enterobacter
- Abnormal tract
- Urinary stasis
- Investigations:
- Clean catch urine: MC&S, Dipstick
- Bloods if unwell/considering IV
- US if recurrent/atypical
- Management:
- Antibiotics
- Encourage fluid intake
- Follow up for children younger than 3 to reduce risk of long term complications
Describe the clinical presentation, investigations and examination findings and management of meningococcal sepsis in children
- Clinically:
- Reduced GCS
- Ill looking child
- Non blanching rash: purpura (bruises)> petichiae (pin point)
- Shock
- Causes:
- Neisseria Meningitides (infects meninges- meningococcal meningitis, blood- meningococcal sepsis)
- Gram negative diplococcus
- Nasopharyngeal carriage
- Saliva and respiratory secretions
- Investigations:
- Bloods: FBC (inflammatory markers) , U&Es (dehydration) , LFTs (hypoperfusion/shock), clotting (may need FFP), CRP, blood cultures
- Meningococcal PCR
- LP
- Management:
- O2
- Fluids
- IV Ceftriaxone
Describe the clinical presentation, investigations and examination findings and management of meningitis in children
- Clinically:
- Neck stiffness
- Bulging fontanelle
- Reduced GCS
- Shock
- Non specific signs: high pitched cries, irritability
- Causes:
- Neisseria Meningitides
- Strep pneumoniae
- Haemophilus influenzae
- Neonates: Group B strep and strep pneumoniae
- Mucus membrane-blood-meninges
- Investigations:
- Bloods
- Lumbar puncture (with caution- raised ICP, impaired clotting)
- CT head
- Management:
- IV ceftriaxone
- IV fluids
- Correction of metabolic disturbance
- IV dexamethasone
- Monitor for complications
Describe the clinical presentation, investigation and examination findings and management of Kawasaki disease in children
What are the possible long term complications?
- Clinically:
- Fever for 5 days + 4 days of:
- Bilateral conjunctivitis
- Mucus membrane changes
- Finger tip peeling/swelling
- Polymorphous rash
- Cervical lymphadenopathy
- Irritability
- Fever for 5 days + 4 days of:
- Causes:
- Autoimmune vasculitis
- The longer the fever, the worse the complications
- Investigations:
- Bloods: FBC, CRP, LFTs, ESR
- Echo
- LP- aseptic
- Management:
- IV immunoglobulin
- Aspirin
- Complications: Cardiac:
- Coronary aneurysms
- Myocardial infarctions
- Valve incompetence
How are fluid boluses calculated in children?
20ml/kg over 10 mins
May give multiple boluses
What comes under the category ‘Green’ on the NICE traffic light system for unwell children?
- Normal colour
- Responds normally
- Content/smiles
- Stays awake/awakens quickly
- No cry or strong/normal cry
- Normal resp exam
- Normal skin and eyes
- Moist mucous membranes
- Absence of amber or red symptoms
