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Emergency Med > Febrile Child > Flashcards

Febrile Child Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Fever in children <2mo

A

100.4 F (38 C)

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2
Q

Fever in children >2mo-<3yo

A

102.2 (39)

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3
Q

Why is there an increased risk for SBI in children <60d

A
  • Immune system immaturity

- Age specific pathogens

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4
Q

Most important component of PE in febrile child

A

General “look” of pt.

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5
Q

Examples of SBI

A
  • Meningitis
  • Bacteremia/sepsis
  • UTI/pyelo
  • Pneumonia
  • Cellulitis
  • Abscess
  • Septic arthritis
  • Osteomyelitis
  • Bacterial enteritis
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6
Q

Ddx in well-appearing febrile child

A
  • UTI
  • Bacteremia
  • Meningitis
  • Pnuemonia
  • SSTI
  • Bacterial enteritis
  • Bone & joint infections (osteo, septic arthritis)
  • Enterovirus
  • URTI
  • Bronchiolitis
  • Viral GE
  • Neonatal HSV
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7
Q

Ddx in ill-appearing febrile child

A
  • SBI
  • Neonatal HSV
  • Enterovirus
  • RSV
  • Ductal dependent R an L sided obstructive lesions
  • Inborn erros of metabolism
  • Congenital adrenal hyperplasia
  • Malrotation w/ volvulus
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8
Q

Most common microbial etiology of septic arthritis

A

S. aureus

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9
Q

ABX used to treat osteomyelitis and septic arthritis (neonates, older children, adolescents)

A

Neonates: oxacillin + gentamicin
Older children: oxacillin + clindamycin
Adolescents: ceftriaxone

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10
Q

What patient population (age, sx) gets automatic admission and what type of treatment or w/u do they receive?

A
  • Neonates <4wks w/ fever (treat w/ IV ABX and full sepsis w/u)
  • ALL ill-appearing children <3yo w/ fever (full sepsis w/u)
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11
Q

M/C SBI

A

UTI

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12
Q

M/C microbial etiology of SBI

A

E. coli

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13
Q

Rates of bacteremia & meningitis are highest in what age group

A

0-4wks (neonates)

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14
Q

Physical exam is unreliable in what age group(s)

A

<2 mo

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15
Q

Sepsis RF in neonates

A
  • Premature
  • Ill-appearing
  • Comorbidity
  • Fever >40C
  • Maternal infection (fever, prolonged ROM, GBS (+), genital HSV)
  • Unimmunized
  • Social factors limiting f/u
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16
Q

Common bacterial etiologies in neonates (0-4wks)

A
  • E. coli

- GBS

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17
Q

Common viral etiologies in neonates (0-4wks)

A
  • HSV
  • VZV
  • Enterovirus
  • Influenza
  • Adenovirus
  • RSV
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18
Q

W/u in febrile neonates

A
  • CBC w/ diff
  • CMP
  • Blcx
  • UA
  • Urine cx
  • LP
  • HSV RF assessment
  • Viral testing ONLY if respiratory sx
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19
Q

What ABX do we use to treat non-focal, non-ill-appearing neonates w/o CSF infection?

A

Gentamicin + ampicillin

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20
Q

What ABX do we use to treat ill-appearing neonates w/ CSF infection/pleocytosis?

A

Ceftazidime + ampicillin

21
Q

Common bacterial etiologies in infants (4-8wks)

A
  • S. pneumo
  • E. coli
  • N. meningitidis
  • HIB (rare d/t vaccine)
22
Q

What is the purpose of the Rochester & Philadelphia criteria?

A

Determine low risk of SBI in infants 4-8wks

23
Q

Rochester criteria (4-8wk infants)

A
  • Well-appearing
  • Full term infant
  • NO prior h/o illness, ABX, hyperbilirubinemia, hospitalization
  • No skeletal, soft tissue, skin, or ear infections
  • CBC normal
  • Other: fecal leukocytes <5 WBC if diarrhea, urine WBC <10
24
Q

Philadelphia criteria (4-8wk infants)

A
  • Well-appearing
  • Reassuring exam
  • WBC <15,000
  • Band to neutrophils <0.2 ratio
  • UA <10 WBC
  • (-) urine GS
  • CSF <8 WBC
  • (-) CSF GS
  • (-) CXR (no infiltrate) - if obtained
  • Stool (-) blood and few to no leukocytes on smear - if obtained
25
Q

What is the clinical prediction rule used to identify febrile infants <60d at low risk for SBI?

A

PECARN rule

26
Q

PECARN rule used these 3 variables to predict risk

A
  • Normal UA
  • ANC <4,090
  • Serum procalcitonin <1.71
27
Q

W/u in febrile infants (4-8wks)

A
  • CBC w/ diff
  • Blcx
  • UA
  • Urine cx
  • Procalcitonin
  • Viral testing ONLY if respiratory sx
28
Q

What ABX do we use to treat non-ill-appearing infants w/o CSF infection?

A

Ceftriaxone

29
Q

What ABX do we use to treat ill-appearing infants w/ CSF infection?

A

Ceftriaxone + vanco

30
Q

Under what circumstance do we add LP to the w/u of an infant?

A

If the infant is admitted (bc focal infection or high risk) and are not meeting low risk criteria w/ intervention

31
Q

If an infection source is not found in a febrile child 2mo-3yo, what diagnostic test is considered?

A

Cath UA/cx in….

  • Females <12mo
  • Uncircumsized males
  • Fever >24 hours or fever >39C
32
Q

What commonly happens with the UA of a febrile child <12mo w/ a UTI?

A

The UA is (-) -> get a cx

33
Q

CBC is NOT recommended in pt. of what age group?

A

2mo-2yo

34
Q

Consider obtaining a CXR in pt. 2mo-2yr if well-appearing, immunocompetent and no obvious source of infection IF……(B recommendation)

A
  • Cough
  • Hypoxia
  • Rales
  • High fever (>39)
  • Fever >48 hrs
  • Tachycardia & tachypnea out of proportion to fever
35
Q

Do NOT order a CXR in pt. 2mo-2yr if well-appearing, immunocompetent and no obvious source of infection IF……(C recommendation)

A
  • Fever 100.4 (38)
  • Wheezing
  • High likelihood of brochiolitis
36
Q

Signs of sepsis - compensated shock

A
  • Resting tachycardia
  • Widened PP
  • Warm distal extremities
  • Brisk cap refill
37
Q

Signs of sepsis - decompensated shock

A
  • Weak distal pulses
  • Delayed cap refill
  • Cool extremities
  • Decrease sensorium
  • Hypotension
38
Q

What is more important than w/u in ED mgmt of sepsis?

A

Stabilization

39
Q

What does stabilization of sepsis in the ED consist of?

A
  • O2 (FM or HFNC)
  • Close monitoring
  • IVF (20 mg/kg bolus)
  • Pan-cx, CXR, CBC, CMP
  • Empiric ABX (immediately in unstable pt., get blcx & CSF cx first if stable)
40
Q

What ABX do we give empirically to septic children in the ED?

A

Ceftriaxone + vancomycin

41
Q

Common infectious etiology of meningitis in neonates

A
  • E. coli

- GBS

42
Q

Common infectious etiology of meningitis in infants/children

A
  • N. meningitidis

- IF UNVACCINATED: S. pneumo, HIB

43
Q

How do infants w/ meningitis present?

A
  • Decrease responsiveness to stimuli
  • Hypotonia
  • Bulging fontanelle
  • Poor feeding
  • Vomiting
  • Paradoxical irritability
  • Lethargy
44
Q

How do older children w/ meningitis present?

A

LIKE ADULTS

  • HA
  • Photophobia
  • N/V
  • Nuchal rigidity
  • +/- Kernig’s/Brudzinski
  • Seizures
45
Q

What does the LP reveal in a pt. (+) for meningitis?

A
  • CSF pleocytosis
  • HIGH protein
  • LOW glucose
46
Q

What ABX do we give neonates w/ meningitis?

A

Ceftazidime + ampicillin

47
Q

What ABX do we give children w/ meningitis?

A

Ceftriaxone + vanco

48
Q

Do NOT delay ABX therapy in pt. w/ meningitis if…..

A
  • Difficulty obtaining LP
  • Difficulty obtaining head CT
  • Unstable pt.
49
Q

What is given to pt. w. meningitis on a case by case basis?

A

Dexamethasone

Emergency Med (3 decks)

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