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Emergency Medicine > Fevers and Seizures > Flashcards

Fevers and Seizures Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What is the job of the ER

A

Stabilize and get to the appropriate department

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2
Q

When is fever the scariest?

A

pediatric patients - sometimes the only symptom they present with

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3
Q

What is a fever and why is it that number?

A

100.4

because we chose it to be this number and have done studies accordingly

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4
Q

What controls the body temperature?

A

hypothalamus makes a set point and cytokines are released

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5
Q

Why are children more susceptible to febrile seizures?

A

Their body temperature increases too fast

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6
Q

What demographic is fever not reliable?

A

Elderly

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7
Q

Average body temperature

A

Probably around 98F

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8
Q

worst place to take a body temperature?

A

peripheral areas

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9
Q

What are the two main ways we take temperatures?

A

Oral or rectal

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10
Q

When might you get an abnormally low oral temp?

A

Cold drink
Panic attack that are

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11
Q

What do you default for fever if they come into the ER?

A

Bacterial
Viral infection

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12
Q

What is most important to look at for fever?

A

Vitals to r/o sepsis

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13
Q

When is hyperthermia common and what clues you into this?

A

Environmental exposure
Warm skin
Do not respond to antipyretics

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14
Q

What drugs can cause fever?

A

Serotonin

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15
Q

What is neuroleptic malignant syndrome

A

Very high fever with muscle rigidity, AMS, and autonomic dysfunction

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16
Q

What is the length of FUO?

A

38.3 = 100.9 F for 3 weeks w/out diagnosis

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17
Q

Why is age important for fever?

A

Use common sense

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18
Q

What history question should you ask for all patients with fever?

A

Ill contacts
Travel
IV drug use (EVER)

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19
Q

What are you worried about for IV drug use EVER?

A

endocarditis
spinal epidural abscess

once in the system, it can be there for ever

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20
Q

Apart from cancer, what are you worried about for constitutional symptoms w/ fever

A

TB

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21
Q

When is fever also common for meds?

A

New meds or dose changes

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22
Q

What makes you worried about sepsis

A

Hemodynamic instability

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23
Q

If a patient comes in with weird vitals but no symptoms?

A

PNA (CXR is sometimes normal - get a CT if not a clear)
UTI (UA is not always positive)

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24
Q

SIRS criteria

A

HR > 90
Resp > 20
Temp <96.8 F (flip the digits of normal) or > 100.4

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25
Q

What is sepsis?

A

SIRS + infection

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26
Q

What do you do for fever?

A

Tylenol or ibuprofen

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27
Q

When do you use tylenol over ibruoprfen?

A

Tylenol is for younger

Ibuprofen for > 6 months

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28
Q

If you have pain + fever, what is used?

A

Toradol IV/IM which is ibuprofen

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29
Q

If you have a neutropenic patient or is expected to be neutropenic in next few days, what do you do?

A

Throw broad spectrum w/out waiting for culture

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30
Q

What med suffix is common for immunocompromised patients?

A

-mab

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31
Q

When do you admit patient in ER?

A

vital sign abnormalities
end-organ damage
>41 C
seizure
meet criteria

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32
Q

Why are pediatric fever worrisome?

A

Lack of mature immune system leads to VAGUE symptoms + risk of spread of infection from system to system (from GU to another tract)

Hard to do a good PE in these patients

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33
Q

MC presenting CC in pediatric ER population?

A

fever :(

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34
Q

What age is the MOST worrying for pediatric fever?

A

< 3 months is REALLY worrying

3+ months is not as worrying

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35
Q

When should a patient see a medical provider for peds fever

A

38C in children < 3 months
39 C in children >3 months

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36
Q

What are you most worried about for infants <3 months with fever?

A

SEPSIS

meningitis
encephalitis
osteomyletis

37
Q

What is the MC pediatric fever cause?

A

Viral - not as concerning

should r/o others with history

38
Q

What is more concerning, viral or bacterial in kids?

A

Bacterial

group B strep, listeria, E coli is worrying

39
Q

If there is a fever + rash, what likely is it?

A

MMR

unvaccinated

40
Q

Roseala vs measels

A

rosealo starts at bottom and goes up

measles starts at top and goes down

41
Q

What is important history to get for infant < 3 month?

A

Birth history
if a patient is 1 week early, then they are considered minus 1 week to be their true age

42
Q

Symptoms of fever in child?

A

NONSPECIFIC

sometimes they do not respond

43
Q

What must a PE of a newborn be?

A

undressed completely to look for infection

44
Q

If you have cough, tachypnea, hypoxia, what do you think?

A

respiratory infection

45
Q

In a child <3 months with fever what should you do right away?

A

Urinary straight catheter right away

also
CBC w/ diff
LP
CXR
Stool sample
CRP and procalcitonin

46
Q

What criteria must be met to be low risk per tinitinally?

A

well-appearing
no immunization w/in 45 hours

(look this over)

47
Q

What population is admitted no matter what?

A

<21 days
some same <28 days

leukocytes in urine
procalcitonin > 0.5
CRP > 20 or ANC > 1000

if not, then send to pediatrician w/in 24 hours

48
Q

When a patient is admitted that is <28 days or 1-3 months high risk, what do you give?

A

Ampicillin + cefotaxime

amped up kid with taxes

49
Q

Infants that are 1-3 months and are low risk, what do you do?

A

F/o with a pediatrician w/in 24 hours IF they have a way to get there.

Inpatient w/ or w/out AB

depends on provider comfort level

50
Q

Etiology of fever in 3-36 months?

A

Viral

51
Q

How do you determine toxicity?

A

general assessment

lethargic, no responses

look at ears for infection

52
Q
A
52
Q

If kids are not UTD on immunizations, what do you do?

A

Get all labs

53
Q

When should you admit 3-36 months?

A

If they look sick
Rocephin + Vanc

54
Q

Does response to antipyretics change admission?

A

NO
can mask infection

55
Q

If a patient is well appearing but blood cultures grow something, what do you do?

A

Repeat ER evaluation

well-appearing = 10 day outpatient

not well appearing = admit with IV AB

56
Q

What is a neutropenic fever often seen in?

A

Cancer patients

57
Q

What is a neutropenic fever?

A

Temp > 100.4 for an hour or a single temp >

Neutrophil 501-1000 = mild/mod
Neutrophil < 500 = severe neutropenia (ADMIT)

58
Q

What is sometimes the only symptom of infection in neutropenic fever?

A

fever alone

often don’t look sick!

59
Q

What is a common history of neutropenic history?

A

chemotherapy

60
Q

What w/o does neutropenia have?

A

Full work up!

Blood cultures

61
Q

What is the treatment of neutropenic fever?

A

Vanc + a cephalosporin

broad spectrum

62
Q

When would you NOT admit a neutropenic fever?

A

score > 20 on MASCC

rare occasion

63
Q

What are the different types of seizures?

A

Primary (idiopathic) seizures no cause can be identified
Secondary (symptomatic) seizures - identifiable neurologic condition is identified
mass lesion, previous head injury, stroke
Provoked seizure - a seizure that occurs within 7 days of an insult ¹
Unprovoked seizure - no acute precipitating factor can be identified
Status epilepticus - seizure activity for ≥ 5 minutes² or two or more seizures without regaining consciousness between the seizures - multiple seizures back to back without recovery
Refractory status epilepticus -

64
Q

what makes a seizure provoked?

A

A seizure within 7 days of an insult

65
Q

What is status epilepticus?

A

seizure activity for ≥ 5 minutes² or two or more seizures without regaining consciousness between the seizures - multiple seizures back to back without recovery

66
Q

what is refractory status epilepticus?

A

persistent seizure activity despite IV administration of 2 antiepileptic drugs

67
Q

What is SUPER important history to get for seizure?

A

Witnesses!

duration
proceeding aura
abrupt or gradual onset

68
Q

Do you remember a seizure?

A

NO

if they say they do, then they are likely lying

69
Q

What is almost 100% sensitive for a seizure?

A

Biting of lateral tongue

ask about cheek pain, if they wet themselves

70
Q

What is the biggest deal in seizure

A

First time seizure or has it happened before

history of seizures = get them out of the door in 15 minutes

71
Q

If a patient has a history of seizure and comes into ER, what do you do?

A

Ask if there is a change, if no, then just out the door

72
Q

If you have a new seizure, what do you do?

A

Consider CT
Get finger stick glucose and it might fix right away

73
Q

What is Todd’s paralysis?

A

A transient focal deficit unilateral after a simple focal seizure.

Must do a w/o for stroke in case

74
Q

How to differentiate a seizure from a non-seizure

A

Abrupt onset
Memory loss of the event
Purposeless movement the whole time
Positical confusion/lethargy

75
Q

What can you use to verify psedoseizure?

A

Use a saline flush and if they move, then it is not a seizure

76
Q

If hx of seizure disorder, what do you do?

A

Get glucose
Check to make sure they take meds
Get serum anti-convuslant drug levels for next provider
HCG

77
Q

Imaging of seizure

A

CT w/out contrast (only w/ if worried of tumor)

78
Q

When do you get a LP for seizure?

A

Fever to r/o meningitis
Subarachnoid

79
Q

What supportve treatment do you do for seizures?

A

Large IV nasapharyngeal airway
IV access for glucose
Get a monitor and adminster O2
Most self-resolve in 5 minutes

80
Q

What is the manage of status epiltehtics

A

IV lorazepam 1st line

if it doesn’t work, give it again or go to 2nd line med:

fosphenytoin (preferred)

monitor O2 and stop patient from hurting themselves

seizing precautions if it works

81
Q

If 1st and 2nd line methods do not work for seizure control what do you do?

A

Induce COMA
EEG

82
Q

When can hyponatremia lead to seizure?

A

<120

give NaCl but titrate slow

83
Q

If a patient has a seizure but not status epliepticus and you see low serum drug levels, what do you do?

A

Can start a new drug or increase drug

if drug level is normal than go home

84
Q

If a patient is doing fine but has no history of seizure, what do you do?

A

Discharge home if normal imaging

NEED to have someone there
no driving

85
Q

If a patient is sus or eclampsia what do you do?

A

IV magnesium sulfate

for recently postpartum patients (patients that just recently gave birth)

86
Q

Febrile seizures, are they concerning?

A

NO only if status epilepticus

<15 minutes
often viral onset
spike in fever (so peds MC)
6 months to 6 years
treat underlying infection

87
Q

useful resource for Height/weight/vitals for

A

pedicalc

Emergency Medicine (14 decks)

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