Fever Flashcards
What are the five features of Kawasaki disease?
- Cervical lymphadenopathy
- Bilateral non-purulent conjunctival infection
- Mucosal changes - cracked lips, strawberry tongue
- Red rash
- Peripheral skin changes - redness/oedema of hands and feet
What are the features of bacterial meningitis?
Neck stiffness
Bulging fontanelle
Reducing consciousness
Convulsive status epilepticus
What are the features of meningococcal disease?
Non blanching rash Lesions >2mm Ill looking child Neck stiffness Cap refill >3 seconds
What are the features of pneumonia?
Chest crackles Tachypnoea Nasal flaring Chest in drawing Cyanosis O2 sats <95%
What are the features of UTI?
Vomiting Poor feeding Lethargy Irritability Abdominal pain or tenderness Urinary frequency or dysuria
What are the features of septic arthritis?
Swelling of a limb or joint
Not using an extremity
Not weight bearing
What is the paediatric sepsis six?
- Give high flow oxygen
- IV access and blood tests
- Give antibiotics
- Consider fluid resuscitation
- Involve specialists early
- Consider inotropic support
What bloods are taken in sepsis?
Blood cultures
Blood glucose
Blood gas
How are fluids given in sepsis?
20ml/kg isotonic fluid over 5-10 minutes
Examine for crepitations and hepatomegaly
When is inotropic support given?
If normal physiological parameters not reached after 40ml/kg fluid
Adrenaline or dopamine
Commonest pathogens for bacterial meningitis under 3 months?
Group b strep
E. coli
Listeria monocytogenes
Commonest pathogens for bacterial meningitis 3 months - 5 years?
Neisseria meningitides
Strep pneumoniae
Haemophilus influenzae B
Commonest pathogens for bacterial meningitis over 5 years?
Neisseria meningitides
Strep pneumoniae
What are the commonest pathogens for viral meningitis?
Adenovirus
Coxsackie
Echovirus
What should a fever system enquiry include?
CNS - bright lights, irritability ENT - pulling at ears, swallowing Resp - cough, breathing Abdo - pain, blood, d&v Urinary - smell, colour, pain Joints - swelling, pain Other - rash, colour, food and drink
What are the features of herpes simplex encephalitis?
Focal neurological signs
Focal seizures
Decreased level of consciousness
What is on the traffic light system for identifying serious illness?
Colour Activity Respiratory Circulation and hydration Other
‘Colour’ parameters on the traffic light system
Green - normal
Amber - pallor reported by parent
Red - pale, mottled, ashen, blue
‘Activity’ parameters on the traffic light system
Green - normal
Amber - decreased, no smile
Red - no response to social cues, appears ill to health care professional, weak/high pitched cry
‘Respiratory’ parameters on the traffic light system
Amber - nasal flaring, RR >50 (under a year) >40 (over a year), O2 sats <95%, crackles
Red - grunting, chest indrawing, RR >60
‘Circulation’ parameters on the traffic light system
Green - normal, moist mucous membranes
Amber - tachycardia, dry mucous membranes, reduced urine output, poor feeding
Red - reduced skin turgor
‘Other’ parameters on the traffic light system
Amber - fever for over 5 days, rigors, limb swelling, not using a limb
Red - non-blanching rash, bulging fontanelle, neck stiffness, seizures
What is the first line for suspected meningitis in a hospital?
IV cefotaxime + amoxicillin - under 3 months
IV ceftotaxime - over 3 months
What is the treatment for suspected meningococcal disease pre-hospital?
IV/IM benzylpenicillin
When does the anterior fontanelle close?
18-24 months
What should be done before an LP?
Blood glucose
What are the CSF findings in bacterial meningitis?
Cloudy Increased opening pressure WBC elevated >100 Low glucose <40% serum Protein elevated >50mg/dl
What are the CSF findings in viral meningitis?
Clear Normal or elevated opening WBC elevated 50-1000 Normal glucose Protein elevated >50mg/dl
What are the CSF findings in tuberculosis meningitis?
Opaque, forms fibrin web Elevated opening WBC elevated 10-1000 Low glucose Protein elevated 1-5g/L
When should corticosteroids be used in meningitis?
Dexamethasone 0.15mg/kg (max 10mg QD) for suspected or confirmed bacterial meningitis when CSF is suspicious
DO NOT start if after 12 hours since antibiotics
What landmarks can be used to identify the L4/5 disc space?
Draw a line between anterior superior iliac crests - L5
Space is just above
What are the contraindications for a lumbar puncture?
Child is unstable Signs of ICP Suspected intracranial mass Convulsions Bleeding disorder Infection at site of LP
How is group b strep treated?
Under 3 months - 14 days cef
Over 3 months - 10 days cef
How is listeria monocytogenes treated?
amoxicillin 21 days, gentamicin 7 days
How is strep pneumoniae treated?
14 days cef
What are acute complications of meningitis?
Seizures
Raised ICP
Coagulopahty
Anaemia
What are long-term complications of meningitis?
Hearing impairment
Epilepsy
Learning difficulties
