Feverish Child Flashcards

1
Q

What are the amber (intermediate risk) signs for a feverish child in the child’s activity?

A
  1. Not responding normally to social cues
  2. No smile
  3. Wakes only with prolonged stimulation
  4. Decreased activity
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2
Q

What are the amber (intermediate risk) signs for a feverish child in the child’s respiration?

A
  1. Nasal flaring
  2. Tachypnoea (as per age range)
  3. Sats <95% on room air
  4. Crackles in the chest
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3
Q

What are the amber (intermediate risk) signs for a feverish child in the child’s circulation and hydration?

A
  1. Tachycardia (as per age range)
  2. CRT >3 seconds
  3. Dry mucous membranes
  4. Poor feeding in infants
  5. Reduced urine output
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4
Q

What are the amber (intermediate risk) signs for a feverish child in the child’s other features? (not colour, activity, respiration, circulation, or hydration)

A
  1. Age 3-6 months, temperature >39
  2. Fever for >5 days
  3. Rigors
  4. Swelling of limb or joint
  5. Non weight bearing limb or not using an extremity
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5
Q

What is the amber (intermediate risk) sign for a feverish child in the child’s colour (skin, lips, tongue)?

A

Pallor reported by parent/carer

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6
Q

What are the red (high risk) signs for a feverish child in the child’s colour (skin, lips, tongue)?

A

Pale, mottled, ashen, blue

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7
Q

What are the red (high risk) signs for a feverish child in the child’s activity?

A
  1. No response to social cues
  2. Appears ill to a healthcare professional
  3. Does not wake or if roused does not stay awake
  4. Weak, high-pitched or continuous cry
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8
Q

What are the red (high risk) signs for a feverish child in the child’s respiration?

A
  1. Grunting
  2. Tachypnoea >60
  3. Moderate/severe chest indrawing
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9
Q

What is the red (high risk) sign for a feverish child in the child’s circulation and hydration?

A

Reduced skin turgor

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10
Q

What are the red (high risk) signs for a feverish child in the child’s other features? (not colour, activity, respiration, circulation, or hydration)

A
  1. Age <3 months, temperature >38
  2. Non-blanching rash
  3. Bulging fontanelle
  4. Neck stiffness
  5. Status epilepticus
  6. Focal neurological signs
  7. Focal seizures
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11
Q

How do you measure temperature in a child below 4 weeks and 5 weeks and above?

A
  1. <4 weeks - electronic thermometer in axilla

2. 5 weeks or more - axilla, chemical dot, or tympanic membrane

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12
Q

What are the steps for safety netting in a feverish child?

A
  1. Check on child during the night
  2. Offer regular drinks - if refusing seek medical help
  3. Look for non-blanching rash by rolling a glass over it
  4. If well but fever continues >5 days then go to A&E
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13
Q

How do you investigate a fever in children under 3 months old?

A
  1. FBC, U&Es, CRP, blood culture, urine dip, CXR, stool culture
  2. LP in all <1 months and 1-3 months if unwell/WCC <5 or >15
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14
Q

How do you investigate a fever in low risk (green) children over 3 months old?

A
  1. Urine for UTI
  2. No bloods or CXR
  3. Observe
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15
Q

How do you investigate a fever in intermediate risk (amber) children over 3 months old?

A
  1. Urine for UTI
  2. FBC, CRP, blood culture
  3. CXR if >39 degrees/WCC >20
  4. Consider LP if <1 years
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16
Q

How do you investigate a fever in high risk (red) children over 3 months old?

A
  1. Urine for UTI
  2. FBC, CRP, blood cultures, U&Es, blood gas, CXR
  3. Consider LP
17
Q

What should you think if paracetamol/NSAIDs do not bring a fever down in a child?

A

Sepsis

18
Q

How do you investigate sepsis in a child?

A
  1. Serial observations
  2. FBC, U&Es, CRP, blood gas
  3. Blood film, bone profile, ESR, glucose, clotting
  4. Listen to chest, ENT exam
  5. Blood culture, urine MCS, nasopharyngeal aspirate for RSV, LP
  6. CXR
  7. Examine for rash