Final (Old material) Flashcards
Accurate temperature measurement in children
Rectal thermometer in children < 3 y.o.
Oral thermometer in children > 5 y.o.
Axillary, temporal, tympanic thermometers are less accurate
Normal rectal temperature range
- 9-100.2F
(36. 6-37.9C)
T/F Degree of fever correlates with severity of illness
False. The general appearance is a stronger indicator. So a low temperature does not negate a serious bacterial illness.
Fever mgmt recs: How? Pharm vs non pharm
- Non-pharmacological -
- hydration
- appropriate clothing and ambient temp
- tepid water baths for temp > 104F
- Do not allow shivering
- Never use alcohol or ice baths
- Pharm mgmt -
- acetaminophen 10-15 mg/kg/dose q 4-6 hours (FIRST LINE)
- ibuprofen (children age 6+ months)
- Temp < 102.5F: 5 mg/kg/dose q 6-8 hours
- Temp >=102.5F: 10 mg/kg/dose q6-8 hrs
- No aspirin, no naproxen
- alternating acetaminophen and ibuprofen may increase risk of med error/toxicity
Causes of fever in neonates (2)
Congenital or acquired infections
1) late onset group B strep
2) acquired anatomic or physiologic dysfunction, i.e. renal
Causes of fever in all children (11)
- bacterial, fungal, parasitic, or viral infection
- vaccines
- biologic agents
- tissue damage
- malignancy - neoplasms
- drugs
- collagen-vascular disorders
- endocrine disorders
- inflammatory disorders - teething
- environmental - heat stroke
- if temp > 105.8F - likely CNS dysfunction such as malignant hyperthermia, drug fever, heat stroke
infants with meningitis don’t present with?
nuchal rigidity
do thorough neuro exam, fontanelles,
Definition of fever without a focus/source
- Acute fever of unknown etiology after examining child that is < 2 years old/24 months
- < 24 months = higher risk for SBI, esp < 3 months old = need workup
Most infants < 90 days have causative agent as ________, however, still need to rule out _____ disease so require a _____ work-up.
- Viral
- Bacterial
- Sepsis
< 24 months/2 yrs → Greatest risk of unsuspected occult bacteremia w/ E. coli.
What are common SBIs with no clinical sx’s? (3)
- UTI
- PNA
- bacteremia
Any child < 3 years old who is ill-appearing should have the following tests…(10)
- CBC w/diff
- Glucose
- CRP
- PCT
- blood cultures
- CSF testing
- UA and culture
- CXR
- Stool cx if diarrhea with blood or mucus in stool
- If in season, rapid testing for influenza/RSV/enterovirus
Red Flags - Infants who need to be admitted to the hospital and for serious bacterial infections: (16)
- Prematurity
- Underlying health conditions
- Parents are unreliable historians and/or caretakers
- Ill or toxic-appearing
- Skin color is ashen, blue, mottled, or pale
- Lethargic, weak
- High-pitched cry, decreased response
- Poor feeding
- tachypnea or tachycardia
- Chest/abdominal retractions
- Petechiae
- Seizure
- Capillary refill > 3 seconds
- decrease UO
- Bulging fontanel
- Non-blanching skin rash
evaluation of fever in young infants 29-60 days (1-2 months)
- ill appearing, get:
- septic workup, admit
- healthy appearing, get:
- CBC/diff
- Blood culture
- UA and urine culture
- PCT
- CRP
- CXR if signs of respiratory symptoms/not clearly bronchiolitis
- if low criteria [well appearing, full term, no system anti, normal labs etc]:
- sent home with strict f/u in 12-24 hrs, seek care if worsens, or if culture is +, if unreliable caretakers
- high criteria:
- Admit and further workup
evaluation of fever in 60-90 day (2-3 month) infant
- if ill appearing = sepsis workup, admit
- if healthy appearing, get:
- CBC/diff
- Blood culture
- UA + culture
- PCT
- if immunized in past 24 hrs & temp < 101.5F, never mind!
all infants this age that has fever need urinalysis
all infants < 3 months to rule out UTI
Subjective data - Current medications - all children (2)
- Immunization history (esp. recent immunizations)
- Meds used to treat fever, illness
Definition: fever of unknown origin
- 100.5F at least once daily x 14 or more days and dx not apparent after careful hx, PE, and noninvasive tests
- temp > 101+ on several occasions > 3 weeks and no dx with 1 week intense investigation
FUO - usually ______, may require _______ consult; ___% self-resolve
- viral
- ID
- 25
Define prolonged fever
single illness in which fever that exceeds that than which is expected for the clinical diagnosis
Sometimes may have prolonged fever that precedes FUO
common causes of FUO in < 6 yrs (6)
- UTI/pyelo
- respiratory infection
- local infection such as abscess
- Juvenile arthritis
- leukemia (rare)
- COVID
common causes FUO in adolescents:
- TB
- Inflammatory bowl disease
- lymphoma
- Autoimmune diseases
- Covid
- chlamydia
Work-up/labs in FUO (16)
- To be done in primary care
- CBC w/ diff
- ESR
- CRP
- UA and culture
- blood cultures
- CMP
- liver and renal function tests
- LDH
- RAF
- ANA
- uric acid levels
- PPD/mantoux skin test or CXR
- sinus XR, mastoid XR, GI XR
- echocardiogram
Kawasaki criteria
persistent fever for at least 5 days PLUS > 4 of these:
- bilateral conjunctival injection, nonpurluent
- change in lips and oral cavity (red, cracked strawberry tongue, diffuse redness mucosa)
- cervical lymphadenopathy (unilateral); > 1.5 cm nodes
- polymorphous exanthema rash in extremities, trunk, perineal regions
- changes in peripheral extremities (edema hands & feet) or perineal area
can also be incomplete who lack classic sx’s = coronary artery abn can confirm dx too
Kawasaki labs if incomplete KD dx
- based on symptoms
A. fever >= 5 days + 4 of the following:
- a. dry, cracked mucous membranes (90% incidence)
- b. maculopapular (or morbilliform) rash, or macular rash in perianal area (70-90%)
- c. Changes in extremities such as edema of hands and feet, erythema of palms and soles (acute), or desquamation of fingers and toes (subacute)
- d. bilateral, non-purulent conjunctivitis
- e. strawberry tongue
- f. Asymmetric ant. cervical lymphadenopathy
- g. irritability h. ST, gallop rhythms, innocent flow murmurs, murmurs of aortic or mitral regurgitation
- incomplete dx include:
albumin > 3
urine > 10 WBC
platelet > 450,000 after 7 days of fever
anemia
total WBC > 15,000
elvation of ALT
coronary artery abnormalities (confirms)




