General / Acute Flashcards
What are normal values for HR?
0-1: 110-160 1-2: 100-150 2-5: 95-140 6-12: 80-120 12-18: 60-100
What are normal values for systolic BP?
0-1: 80-90 1-2: 70-95 2-5: 85-100 6-12: 90-110 12-18: 90-120
What are normal values for RR?
0-1: 30-40
2-5: 25-30
6-12: 20-25
12-18: 15-20
What tool is used to assess children with a fever?
NICE traffic light system for <5 years
All green - low risk
Any in amber (but no red) - intermediate risk
Any in red - high risk
What signs and symptoms put a feverish child <5 in the low risk category?
Normal colour (skin, lips tongue)
Responds normally to social cues
Content/smiles
Stays awake or awakens quickly
Strong normal cry or not crying
Normal skin and eyes
Moist mucous membranes
What signs and symptoms put a feverish child <5 in the low risk category?
Normal colour (skin, lips tongue)
Responds normally to social cues
Content/smiles
Stays awake or awakens quickly
Strong normal cry or not crying
Normal skin and eyes
Moist mucous membranes
What signs and symptoms put a feverish child <5 in the intermediate risk category?
Colour: PALLOR of skin/lips/tongue reported by parent/carer
Activity: NOT responding normally to social cues, NO smile, wakes only with prolonged stimulation, decreased activity
Resp: NASAL FLARING, TACHYPNOEA (>50 if 6-12 months, >40 if >12 months), SATS <95%, CRACKLES
Circulation: DRY mucous membranes, POOR feeding (infant), REDUCED URINE output, CAPILLARY REFILL >3s, TACHYCARDIA (>160 if <1, >150 if 1-2, >140 if 2-5)
Other: 3-6 months + temp 39, fever lasting 5 days, rigors, swelling of limb or joint, non-weight bearing limb / not using extremity
What signs and symptoms put a feverish child <5 in the HIGH risk category?
Colour: PALE / MOTTLED / ashen / BLUE skin, lips or tongue
Activity: No response to social cues, appearing ill to healthcare professional, does not wake or if roused DOES NOT STAY AWAKE, WEAK, HIGH-PITCHED or CONTINUOUS cry
Resp: GRUNTING, tachypnoea (RR >60), moderate or severe chest INDRAWING
Circulation: Reduced SKIN TURGOR
Other: <3 months + temp 38, non-blanching rash, bulging fontanelle, neck stiffness, status epilepticus, focal neurological signs, focal seizures
Based on age, which temperatures are considered intermediate or high risk?
<3 months + temp 38 - high risk
3-6 months + temp 39 - intermediate risk
How should a <5y with fever be assessed (investigations etc)?
All require temp, HR, RR and cap refill. If HR or capillary refill abnormal, measure BP.
If >6 months do not use of height of body temperature alone to identify those with serious illness. If given antipyretics do not rely on decrease/lack of decrease in temp to differentiate seriousness level. Do not use duration of fever to predict likelihood of serious illness, however, if >5 days should be assessed for Kawasaki disease.
Assess for dehydration (capillary refill, skin turgor, abnormal respiratory pattern, weak pulse, cool extremities).
Assess for signs and symptoms of specific illness (meningococcal disease, bacterial meningitis, herpes simplex encephalitis, pneumonia, UTI, septic arthritis / osteomyelitis, Kawasaki disease).
Enquire about travel + consider imported infections
Test urine but signs suggesting pneumonia do not require CXR if not admitted.
When assessing child <5 with fever, what would suggest meningococcal disease?
Non-blanching rash, particularly with 1 or more of the following:
ill looking child, lesions >2mm diameter (purpura), CRT >3s, neck stiffness
When assessing child <5 with fever, what would suggest bacterial meningitis?
neck stiffness, bulging fontanelle, decreased consciousness, convulsive status epilepticus
When assessing child <5 with fever, what would suggest herpes simplex encephalitis?
focal neurological signs, focal seizures, decreased level of consciousness
When assessing child <5 with fever, what would suggest pneumonia?
tachypnoea (>60 if 0-5m, >50 if 6-12m, >40 if >12m)
crackles, nasal flaring, chest indrawing, cyanosis, sats <95%
When assessing child <5 with fever, what would suggest UTI?
Vomiting Poor feeding Lethargy Irritability Abdo pain or tenderness Urinary frequency or dysuria
When assessing child <5 with fever, what would suggest septic arthritis?
swelling of limb or joint
not using an extremity
non-weight bearing
When assessing child <5 with fever, what would suggest Kawasaki disease?
fever >5 days and at least 4 of the following:
bilateral conjunctival injection change in mucous membranes change in extremities polymorphous rash cervical lymphadenopathy
How should a <3m with fever be assessed (investigations etc)?
Temp, HR and RR recorded
FBC, culture, CRP, urinalysis, CXR only if respiratory signs, stool culture only if diarrhoea present
LP if <1 month, 1-3 months and appearing unwell or 1-3 months with WBC <5 or >15
Parenteral antibiotics: all <1m, all 1-3m appearing unwell or with WBC <5 or >15
How should a child over 3 months with fever in the ‘high risk’ zone be assessed (investigations etc)?
FBC, blood culture, CRP, urine testing, U&Es, blood gas
LP if not contraindicated
CXR (irrespective of temp and WBC)
How should a child over 3 months with fever in the ‘intermediate risk’ zone be assessed (investigations etc)?
Urine sample, FBC, CRP, cultures, LP if <1 year, CXR if temp 39 and WBC >20
How should a child over 3 months with fever in the ‘low risk’ zone be assessed (investigations etc)?
Urine sample
Assessed for symptoms / signs of pneumonia
Do not routinely do bloods / CXR
When should antipyretics be given for children with fever?
Only if distressed - consider paracetamol OR ibuprofen (not simultaneously), only for as long as appears distressed, consider changing to the other agent if distress not alleviated
If child with fever is being cared for at home, what advise should be given?
Regular fluids (breast milk most appropriate if breastfed)
Advice on detecting dehydration: sunken fontanelle, dry mouth, sunken eyes, no tears, poor overall appearance
Identifying non-blanching rash
Check child during night
Keep away from nursery / school while fever persists
Seek further advise if: seizure, non-blanching rash, less well than when they sought advice, LONGER THAN 5 DAYS, carer distressed or concerned unable to look after child
