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Paediatrics > FEVER > Flashcards

FEVER Flashcards

1
Q

What is a massive red flag

A

Fever >5 days

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2
Q

What does it suggest

A

Malignancy

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3
Q

What are common organisms in neonates

A

Group B strep
E.coli
Listeria monocytogenes
HSV / VZV = high mortlality

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4
Q

What are common organisms in children

A 
S.pneumonia
H.influenza
Meningococcal
Strep A
S.aureus
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5
Q

What are non infectious causes of fever

A 
Kasawaki
JIA
SLE
Leukaemia / lymphoma
Neuroblastoma
Medication
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6
Q

What are symptoms of sepsis / unwell child

A 
Fever
Rigors
Hypothermia 
Hypoglycaemia
D+V
Rash
Shock
DIC 
Dehydration
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7
Q

What suggests dehydration

A 
Low BP 
Increased CRT
Increased RR + HR
Cool periphery 
Sunken fontanelle
Dry mouth
Decreased urine output 
Skin turgor
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8
Q

What suggests altered mental status

A 
Lethargy
Irritable
Floppy
Seizure
Decreased GCS
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9
Q

What suggests poor perfusion

A 
Long CRT
Cold periphery 
Cold
Mottled 
Pale
Cyanosed 
Decreased urine
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10
Q

What suggests septic shock

A 
Tachycardia
Tachypnoea
Poor perfusion 
Altered mental 
CRT >4s
Cool periphery
Decreased urine
BE <5
Agitated / drowsy
Hypotension = very late sign
- Child can be normotensive and very ill
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11
Q

What are amber signs requiring further assessment / safety net / senior advice / observation

A

3-6 months

Colour
Pallor

Activity 
No smile
Not responding to social cues 
Decreased activity 
Will wake with prolonged stimulation 
Poor feeding 
Resp 
Nasal flaring
RR >50
- THINK SEPSIS / ACIDOSIS 
Sats <94
Crackles 
Circulation 
Tachycardia
- Difficult due to anxiety / crying 
CRT >3s
Dry membrane 
Decreased urine
- Wet nappy suggest hydrated

Other
Rigors
Fever >5 days

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12
Q

What are red flags = urgent assessment and senior support

A

Colour
Mottled
Cyanosed

Activity 
No response 
Appear ill 
Not awake 
High pitched weak cry
- Suggest meningeal irritation 
Continuous cry

Resp
RR >60
Recessions / undraping
Grunting

Circulation
Reduced turgor

Other 
<3 month
If <1 month will get full work up with culture and LP even if look well 
Rash non-blanching 
Bulging fntanelle
Stiff neck
Seizure / status
Focal neuro
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13
Q

What are special circumstances where child should always be referred

A

<3 months
Immunocompromised - post chemo / steroids
Fever >5 days

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14
Q

What should be done for a child with fever of unknown origin

A

Bloods
Blood culture
Imaging

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15
Q

When is it not needed

A

If source of fever known

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16
Q

What bloods

A 
FBC
Film 
U+E
LFT
CRP
Coag
X match
Glucose
Ca, Mg
Blood gas
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17
Q

What bloods are part of full septic

A 
FBC for WCC 
U+E
Coag for DIC 
CRP - rise faster in infection 
ESR - rise faster in AI 
Glucose
Blood gas
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18
Q

What should you culture

A 
Relevant to Hx 
Blood
Throat
Urine
Stool if diarrhoea 
CSF
Skin / wound 
NPA 
- Helpful for viral bronchiolitis to prove RSV
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19
Q

What cultures if doing full septic

A

Blood
Urine
CSF
Throat

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20
Q

What imaging should be done in full septcic

A

CXR

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21
Q

What other imaging and what should be done to show end organ

A

Abdo USS
Limb X-Ray
CT / MRI
ECHO

U+E
LFT
Bone profile

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22
Q

When should a child get a full septic screen + LP if present with fever (even if well)

A

<3 months
Immunocompromised
>5 days

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23
Q

What should you do if child >3 months + red flags

A

FBC
Blood culture
CRP
Urine

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24
Q

What should you do if no features serious illness

A

Urine dip

Assess for pneumonia

25
Q

What should you record in all children

A 
Temp
HR
RR
CRT
Signs of dehydration
26
Q

How do you treat child with fever if admitted

A

Monitor and observe

Anti-pyretic 
- Paracetamol 
- Ibuprofen 
Encourage fluid
Can give ORS if dehydrated

Ax / sepsis 6 if appropriate
O2 if <92%
20ml / kg bolus saline if shock
Inotropic support if no improvement

27
Q

What do you do for <3 months with fever

A

Admit for assessment
Full septic screen as fever may be only Sx of severe illness
LP when stable

28
Q

What Ax to neonate and <3 months

A

Gent and benpen to neonate
Ceftriaxone and amox
Aciclovir

29
Q

What do you do for immunocompromised

A

Specific policy

30
Q

When would you give IV Ax

A

<1 +-
Impaired consciousness +-
Shock +-
Signs of meningococcal +-

31
Q

What do you do if you suspect encephalitis

A

IV Aciclovir

32
Q

How do you safety net

A 
Open access
Give regular fluid 
Check child at night 
Blood in stool
Signs of dehydration
Non-blanching rash
Contact If get worried or fever >5days
33
Q

Should you ever prescribe Ax without a source

A

NO

34
Q

What are CI to LP

A 
Raised ICP
-Focal neuro
-Papilloedema
-Bulging fontnelle 
DIC
Cerebral herniation
Meningococcal septicaemia
35
Q

What is important in the history of fever / any unwell child

A

Do they require urgent intervention

  • ABCDE
  • PEWS / vital signs
  • Do they appear well or sick - according to person
General  
Onset, duration, progression, variation
Systemic symptoms
Urine?
Bowel? 
E+D?
Any rash / skin change?
Activity?
Crying? 
FTT
Specific 
Resp Sx - apnoea / grunt / distress / same as adult 
ENT - sore throat / ears / discharge 
GI - D+V / pain 
Urinary - pain / freq / nocturia / change colour or smell 
CVS - FTT / sweat / poor feed
Neuro - behaviour 
Derm - skin change 
Ortho - limp / not using 
Other 
RF 
Contacts
Vaccination Hx 
Recent travel 
PMH
- Underlying disease
- Medications
36
Q

How do you examine a child with fever

A 
ABCDE 
If unstable = anaesthesistist
PEWS / Vitals (temp, HR, RR, CRT, BP, sats)
Respiratory - wheeze, effort, added sounds 
CVS - murmur, perfusion, dehydration
Abdomen - tender? distension?
Rash
Nodes
ENT
37
Q

What causes persistent fever

A 
Malignancy
Kawasaki
HSP
Endocarditis
UTI
Aspecific viral = common
38
Q

What is a maculopapular rash

A

Red bumps on flat red skin
Macules + papules
BLANCH

39
Q

What causes maculopapular rash

A 
Viral 
Early meningococcus so beware
Drugs
Enterovirus
Parovirus
EBV
CMV
HIV
Measles
40
Q

What is a purpuric rash

A

Petechiae >2cm

NO BLANCH

41
Q

What causes purpuric rash

A 
Meningococcal
HSP
ITP
Enterovirus
Rubella
CMV
TORCH 
Trauma
42
Q

What causes vesicobullous rash

A

Enterovirus
HSV
VZV

43
Q

Why should a child with joint swelling / non weight bear <3 be referred

A

More likely SA / trauma

44
Q

What should child with green symptoms

A

Treated at home

Safety net

45
Q

When do you really worry with fever

A

<1 month

Full septic screen

46
Q

What is a fever

A

Elevation exceeding normal
>37.5 = low grade
>38 = fever
Does not predict severity

47
Q

What is fever with no focus

A

Common in first 48 hours as illness may not have progressed

More investigation need

48
Q

What is prolonged

A

Longer than expected for disease

e.g. GI 10 days or EBV 3 weeks

49
Q

Fever unknown origin

A

> 3 weeks with no cause identified

50
Q

What is early onset sepsis

A

Neonatal - 48 hours

Usually GBS etc

51
Q

What is late onset

A

48 hours to one month

Can be from mother or environment

52
Q

What is neutropenic

A

<1 neutrophils but temp >38

53
Q

When is a fever not always present

A

Newborn
Immunocompromsied
Steroid

More vulnerable and show less signs so low threshold for Ax

54
Q

What does fever do

A 
Increase BMR 
- Weight loss if chronic
Increase insensible
- Increase fluid requirement
Increased HR
- Sepsis vs response of fever
55
Q

What causes fever

A

Pyogene from infection / inflammation. / malignancy release cytokines and change core temp at hypothalamus

56
Q

What is Multi-System Inflammatory Syndrome

A 
Fever >3 days
Hypo / shock / myocardial dysfunction / coagulopathy / GI upset
Raised inflammatory
- CRP / ESR / proclacitonin
Evidence of COVID contact 
No other cause
57
Q

What should you write in notes

A

What you think it is
No signs of
- Conditions you don’t want to miss

58
Q

What conditions

A

SEPSIS
Other serous bacterial.- meningitis / pneumonia / UTI
Leukaemia
SA etc.

59
Q

What are options

A

Send home with safety net
Admit for observation
Admit for screen

Paediatrics (35 decks)

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