Fever Flashcards
Infectious causes vary depending on 3 criteria
1 age of the child < 3/12 much more prone to SBI (low immune fn)
<4/52 12-15% are SBI
2 immunizations status of child ( fully immunized 1% SBI Not fully immunized 5% SBI)
3 geography eg malaria Ross river fever, dengue
Difficulties assessing the young child
1 lack of localizing signs
2 signs difficult in an irritable Child
3 signs are non specific eg D/V can be Lower lobe pneumonia, meningitis, UTI, meningitis
4 URTI infection does NOT rule out a SBI underlying
Signs of toxicity ABCD
A alert / arousal level
B breathing grunting increased WOB
C circulation color , capillary refill
D decline in fluids in ( taking <50% of normal fluids)
Fluids out UO <4 wet nappies per day skin turbot , mm
DEFG DONT forget Glucose
Children <3/12 with a fever
1 don’t localise infection well
2 can appear well / not appear unwell
3 can deteriorate quickly
4 URTI does not rule out SBI
Full examination from top to toe fontaelle Face mouth HC rashes ENT LN genitals chest CVS Abdoman Neuro Musculoskeletal Limping limb movements
Investigations in a child <3/12 with a fever
FBC and diff Blood cultures Urine MCS LP proteins glucose cells For ALL <1/12 For most 1-2/12 For some 2-3/12 CXR
Febrile child <3/12
Admit to hospital
Septic work up
IV antibiotics
Amoxicillin and gentamicin
Febrile child <12/12
7% have UTI Bag urine no use for culture Nitrate + high Pr of UTI <12/12 in/out catherer or Suprapubic aspirate >12/12 ? Clean catch/
When would you consider a CXR in a Febrile child
<3/12 no localizing signs
Increased RR / low oxygen stats
Temp>39 no localisng sings
Young children can have penumonia with NO clinical signs TRAP
Contraindications to LP
1 decreased LOC 2 focal Neuro signs 3 bleeding disorder 4 local infection at site of LP 5 unstable vital signs
Indications for empiric use of antibiotics
1 febrile neonates and baby <3/12
2 any toxic/severely unwell child
GCS in paed
Alert to
Voice
Pain
Unresponsive
