Feverish child in the community

Question 1

Signs which might indicate increased work of breathing

Answer 1

Tracheal tug, recession, increased respiratory rate, abdominal breathing, cyanosis

Question 2

What features might suggest epiglottitis

Answer 2

Until recently, the typical presentation has been a 2–4 year old child with a short history of fever, irritability, dyspnoea, dysphonia and dysphagia, pooling of oral secretions, and drooling of saliva. The child may be sitting forward, breathing carefully. As the use of Haemophilus influenzae type b conjugated vaccine increases, the typical person presenting with epiglottitis is an adult rather than a child.

Question 3

Why is it important to consider epiglottitis before examining someones throat

Answer 3

rapidly progressive cellulitis of the epiglottis and adjacent structures that has the potential to cause abrupt and complete airway obstruction. People with suspected epiglottitis should not have their throat examined unless there are facilities for immediate intubation/tracheotomy because of the possibility of precipitating complete airway obstruction or cardiopulmonary arrest

Question 4

What are the Centor Criteria

Answer 4

Presence of tonsillar exudate
Presence of tender anterior cervical lymphadenopathy or lymphadenitis
History of fever
Absence of cough

Question 5

Need for antibiotics based on Centor Criteria

Answer 5

Centor score 3 or 4 suggests that the person may have bacterial infection (40–60% chance) may benefit from antibiotics treatment.
Absence of three or four of these signs suggests that the person is unlikely to have an infection (80% chance), and antibiotics treatment is unlikely to be necessary.