Fever - Hoffman Flashcards
Fever Criteria
Rectal:
Oral:
Axillary:
Rectal: 100.4 F or 38 C
Oral: add 1/2 degree, starts at 99.9 F
Axillary: add 1 degree, starts at 99.4 F
Aural - accurate if perfect seal achieved
Fever Without a Source
children with a fever lasting for one week or less without adequate explanation after a careful history and thorough physical examination
Fever of Unknown Origin
fever > 101 F of at least 8 days duration
no diagnosis apparent after initial outpatient or hospital evaluation
All babies 3 months or younger with a fever of 100.4 or higher MUST
BE SEEN THAT SAME DAY!
Fever in Infants < 3 months: Bacterial S&S
bacterial infections
s&s: low grade fever, poor feeding, irritability, sleepiness/sleeplessness
Fever in Infants < 3 months: History
Associated Symptoms: respiratory, GI, ENT
Behavioral Symptoms: poor feeding, irritability, poor sleeping, abnormal cry
Exposure to Sick Contacts: siblings, babysitter, day care
Previous Illness
Birth History
Fever in Infants < 3 months: Physical Exam
Gestalt
Abnormal Vital Signs
Toxic Appearance
Signs of Localized Infection
Toxic Appearance
irritability inconsolability poor perfusion poor tone decreased activity lethargy
Common Pathogens < 3 months - Bacteremia
S. pneumoniae Hib group B strep N. meningitis salmonella Listeria monocytogenes
Common Pathogens < 3 months - UTI
E. coli
Common Pathogens < 3 months - Pneumonia
S. aureus
S. pneumoniae
group B strep
Common Pathogens < 3 months - Meningitis
S. pneumoniae Hib group B strep meningococcus herpes simplex enterovirus
Sepsis Evaluation
CBC w/ differential Serum Glucose Lumbar Puncture Blood Culture Urine Culture Inflammation Indicators: ESR, CRP, Procalcitionin Consider: stool culture, CXR
When to admit fever in infant < 3 months for empiric antibiotics? (3)
Toxic Looking
< 1 month of age
Poor social situation
Outpatient Observation Fever < 3 months
Option 1: blood culture, urine culture, lumbar puncture - Ceftriaxone - re-evaluate in 24 hours
Option 2: urine culture, careful observation
Fever in Children < 3 years
most illness in this age group are self-limited viral infections
increased risk of occult bacteremia
Common Pathogens for Fever in Children < 3 years
S. pneumoniae
Hib
N. meningitis
non-typhoidal Salmonella
UTI and pneumonia are possible causes of occult infection
Fever in Children < 3 years - History
Functional Status: oral intake, activity level, irritability
Cough, Vomiting, Dysuria, Frequency, Potty Accidents
Immunization Status!!!!
Physical Exam Children 3-36 Months - Findings warranting extra attention
Toxic Appearing Cyanosis Hypo/Hypervenilation Abnormal Vital Signs - SpO2 < 95% Tachycardia Tachypnea Lesions in Oropharynx Abdominal Tenderness Pain with bone palpation or passive ROM Petechiae, cellulitis, viral exanthem
Gestalts in feverish children < 3 years
Alertness
Playfulness
Irritability
Consolability
Risk Factors for Occult Bacteremia
Temp > 102.2 F
WBC > 15,000/mm3
Elevated neutrophils or bands
Elevated ESR, CRP or PCT
What type of fever has:
high spike and rapid resolution
Intermittent Fever
TB, lymphoma, JIA/JRA
What type of fever has:
fluctuant peaks, but doesn’t return to normal
Remittent Fever
viral, endocarditis, sarcoid, lymphoma, atrial myxoma
What type of fever has:
fever persists with little fluctuation (unless meds given)
Sustained Fever
typhoid fever, typhus, brucellosis
What type of fever has:
fevers that relapse after 1 or more days with no fever
Relapsing Fever
Malaria, rat-bite fever, Borrelia infection, lymphoma
What type of fever has:
episodes of fever more than 6 months duration
Recurrent Fever
other causes: metabolic defects, CNS abnormalities, immunodeficiency
Fever of Unknown Origin
weight loss drug/medications immunizations immunosuppressive therapy Pica exposure to soil borne or water borne organisms history of blood transfusions travel exposure to animals ticks of mosquitos recent surgery or dental work tattoos, body piercing sexual activity
Fever of Unknown Origin - Skin Examination
presence of sweating
petechiae
rash
sparse hair
Fever of Unknown Origin - Eye Examination
Conjunctivitis Retinopathy Absence of pupillary response Absent tears or corneal reflexes Abnormal fundoscopic exam
Fever of Unknown Origin - Oropharynx Examination
Hyperemia of posterior pharynx Dental abscess Abnormal Dentition Smooth tongue Ginigival Hypertrophy
Fever of Unknown Origin - Lymph Node Examination
Enlarged and/ore multiple lymph nodes
Fever of Unknown Origin - Chest Examination
Crackles
New onset murmur
Fever of Unknown Origin - Abdomen Examination
Organomegaly
Tenderness with liver palpation
Fever of Unknown Origin - Musculoskeletal
Tenderness to bones or muscles
Hyperactive DTRs
Fever of Unknown Origin - GU
STD testing
Careful exam for any masses or abscesses
Stool should be examined for occult blood
