Feverish Child Flashcards
What is a likely diagnoses from the video?
Meningococcal disease
Meningitis
How urgent is this situation?
Emergency
What are the causes of meningitis?
Neissaria meningitis
Streptoccocus pneumoniae
Haemphilius influenzae
What is meningitis?
Infection of the protective membranes that surround the brain and spinal cord (meninges)
Most common in babies, young children, teenagers and young adults
Can cause life-threatening blood poisoning (septicaemia) and result in permanent damage to the brain or nerves
What are the sign and symptoms of meningitis?
Fever Vomiting Headache Non-blanching rash Altered mental state
Photophobia
Kernig’s sign
Brudzinski’s sign
What are the sign and symptoms of meningococcal disease?
Fever Vomiting Headache Non-blanching rash Altered mental state
What are the sign and symptoms of septicaemia?
Fever Vomiting Headache Non-blanching rash Altered mental state
Shock
Hypotension
Increased cap refill
Cold
What is Kernig’s sign?
Kernig’s sign is performed with the individual lying on their back with their hips and knees bent. The clinician will then slowly attempt to straighten the leg. If pain or resistance is felt, the Kernig’s sign is said to be positive
What is Brudinski’s sign?
Brudzinski’s sign is positive when passive forward flexion of the neck causes the patient to involuntarily raise his knees or hips in flexion
What is the management of suspected meningitis in primary care?
Organise immediate transfer to hospital by telephoning 999
Single dose of parenteral (IM/IV) benzylpenicillin asap, unless allergic
What do you do if there is a non-blanching rash?
Transfer without antibiotics
What would you do for the child in hosptial?
IV antibiotics ASAP
Fluids
Blood - PCR to look for nisseria
Lumbar puncture? but can be problematic if raised ICP
What are fontanelles?
Fontanelles are the soft spots on an infant’s head where the bony plates that make up the skull have not yet come together
Why do we do a lumbar puncture?
Look at WCC Check protein in CSF Glucose Gram staining Microbiological cultures
How do we judge if there is raised ICP?
CT is unreliable in judging raised ICP
Clinical assessment should be used
e.g. feeling fontanelles
What does bacterial CSF look like?
Turbid
Lots of protein
+ve gram staining in 60-90%
Raised pressure
What does viral CSF look like?
Clear
Not a lot of protein
Normal or raised pressure
What does fungal CSF look like?
Fibrin
Not a lot of protein
When calling the SpR anaesthetist what information would you want to convey?
Patient details - name, DOB, age, weight etc.
Current condition of the infant (stable/unstable), how urgently they need to be seen
Drug allergies
AMPLE
(Allergies, medication, past history, last meal, events)
What is considered a normal temperature?
36.5 - 37.2
lower in axilla
higher in ear
high temp = >38
What is important in the history from the parent?
how long? rash? blanching or non-blanching? abnormal crying? limb or join problems? vomiting or diarrhoea? travel? feeding? urine output?
What else is important to consider in the parental history?
Parental anxiety and instinct
Social and familial circumstances
Other illnesses affecting the child
How do you measure temperature in infants younger than 4 weeks?
Electronic in axilla
How do you measure temperature in a child between 4 weeks and 5 years?
Electronic in axilla, chemical dot in axilla or infrared tympanic
What other than temperature should be examined in a child?
Skin, lips and tongue colour
Examine respiratory system
Examine cardiovascular system
How is tachypnoea defined in children?
> 60 breaths per minute at age 0-5 months.
50 breaths per minute at age 6-12 months.
40 breaths per minute at age older than 12 months
How do we assess level of hydration in a child?
Eyes normal? Reduced skin turgor? Are the mucous membranes moist? Cap refill? Extremities temp? Feeding and urine ouput
What other differentials should be considered in a acutely unwell child?
Herpes simplex encephalitis Pneumonia UTI Septic arthritis and osteomyelitis Kawasaki disease
What system should be used to assess risk of serious illness?
NICE Traffic light
Any symptoms in a certain column warrants that degree of risk
What do green/amber/red symptoms require?
Red - seen within 2 hours if not considered life-threatening
Amber - Assessor to judge urgency of appointment
Green - Managed at home with advice for parents
What is home pyretic treatment for children?
Do not under/over dress Paracetamol/Ibuprofen Regular fluids Monitor for rashes Away from school settings
When should parents seek further help?
Seizure Non-blanching rash Less well than when assessed by healthcare professional Parent is worried Fever lasts longer than 5 days
What ABs do we use to treat children 3 months or older?
IV Ceftriaxone
What ABs do we use to treat children younger than 3 months?
IV Cefotaxime plus amoxicillin or ampicillin
When would vancomycin also be used?
When there is a travel history
Prolonged or multiple exposure to ABs
When must ceftriaxone not be used?
Premature babies
Babies in jaundice
