The Febrile Child Flashcards
How would you initially assess a febrile child?
ABCDE
How would you identify a fever in a child?
- History of the fever
-
Thermometer
- <4 weeks - Electronic axilla thermometer
- >4 weeks - 5 years - Infra-red tympanic or electronic axilla
How would you go about examining the child?
- ABCDE
- Observations and trends (HR, RR, T0)
- Perfusion/ CRT/ Colour
- Respiratory effort/ added sounds
- Abdominal tenderness/ distension
- Play/ Interaction/ Fontanel/ Posture
- Rash/ Nodes/ Ears/ Throat
In terms of paediatric primary assessment, how would you assess the airway?
Is the airway noisy (snoring, stridor, wheeze, grunting, muffled or hoarse speech)?
In terms of paediatric primary assessment, how would you assess the breathing?
- Positioning
- Effort
- Rate
- Cyanosis
- Examination
- SpO2
What would you want to know about the positioning of a child in the context of breathing assessment in paediatric primary assessment?
- Will the child lie flat?
- Are they in the tripod or “sniffing” position?
What would you look for on inspection when assessing respiratory effort of a child in a paediatric primary assessment?
- Accessory muscles
- Head bobbing (infants)
- Minimal/paradoxical movement of the chest wall
- Sternal, supra-clavicular, sub-sternal, or intercostal recession
- Nasal flaring
- Grunting
What would you do in an examination of the respiratory system in a child when assessing their breathing in a primary paediatric survey?
- Expansion
- Air entry
- Percussion
- Tracheal position
How would you assess circulation in a child as part of the paediatric primary assessment?
- Skin colour - normal, or is it pale or mottled?
- Increased respiratory rate without increased work of breathing
- Cool peripheries
- Pulse - rate, rhythm, volume
- Cap refill time
- Blood Pressure
What would you do to assess disability in a child as part of the paediatric primary assessment?
- AVPU score
- Mobility
- Interactiveness
- Crying
- Stiff/floppy
- Blood Glucose
What would you do to assess Exposure in a primary paediatric survey?
- Is there evidence of fever
- Is there a non-blanching rash present
- Any other obvious sinister signs
What aspects would you cover in a history when assessing a febrile child?
- Timing of onset and duration
- Progression and variation
- Systemic effects (Appetite/ Lethargy)
- System specific questions (Cough, D+V)
- Special considerations (Risk factors, PMH)
- Infective contacts
What would be signs/features on investigation of progressive septicaemic shock?
- Base excess < -5
- Increasing tachycardia/tachypnoea
- PaO2 < 10kPa/Sats <95%
What are late signs of septicemic shock?
- Agitation, drowsiness
- Hypotension - last thing to go
What would be potential causes of a fever in a child?
- Upper Respiratory Tract infections
- Croup
- Whooping cough
- Bronchiolitis
- Pneumonia
- Gastroenteritis
- Non-specific viral illness
- Lower Respiratory Tract Infections
- UTI
- Meningitis
- Septicaemia
- Septic arthritis/osteomyelitis
- Non-infectious diseases
What investigations would you consider doing in a child with fever?
- Bloods - FBC/Coag/Cross match, CRP, U+E, LFT, Glucose, VBG
- Orifices - Urine/throat/stool swab
- Xrays/Imaging - CXR
- ECG
- Special tests - LP
What could you look for in a FBC blood result from a febrile child?
- Platelets - high or low
- WBC - high or low
Why would you do a clotting screen in a febrile child?
Look for evidence of DIC
What could you look for using U&Es in a febrile child?
- Renal Compromise
- SIADH
Why can blood glucose increase in a febrile child?
Stress response - to accomodate fight or flight response
Why can blood glucose decrease in a (non-diabetic) febrile child?
Due to poor feeding
What does a raised CRP indicate?
An acute-phase protein of hepatic origin that increases following interleukin-6 secretion by macrophages and T cells
CRP is a more sensitive and accurate reflection of the acute phase response than the ESR
What can blood gases show in a febrile child?
Metabolic/mixed acidosis
What are the parts of a septic screen?
- Blood culture
- CRP
- Urine Sample
- FBC + differential white cell
What can you do in addition to a septic screen?
- CXR
- LP
How would you initially manage a febrile child?
ABCDE
- Antipyretics - ibuprofen/paracetamol
- Assess if need for resuscitation - 20 ml/kg bolus if in clinical shock
- Antibiotics - IV Ceftriaxone/Cefotaxime - if very unwell or <3 months
- Observe in hospital
- Treat cause
What dose a base excess < -5 indicate?
Increasing metabolic acidosis
What antibiotics would you empirically treat a child with a fever who is very unwell or < 3months?
IV ceftriaxone
How would you investigate a child < 3months old with a fever?
Full septic screen + LP regardless
What advise would you give to parents with a febrile child that you had decided to manage at home?
Regularly check on child, and:
- Offer regular drinks
- Look for signs of dehydration
- Look for non-blanching rashes
- If convulsing - seek medical advice
- If fever lasts > 5 days, seek medical advise
What would you regard as amber flags in a child with a fever when doing an ABCDE assessment?
- A - none
- B - nasal flaring, tachypnoea, sats < 95%
- C - pallor, tachy, prolonged CRT, reduced UO, dry mucus membranes
- D - reduced activity, not responding normally
- E - rigors, fever in 3-6 month old
What would you regard as red flags in a child with a fever when doing an ABCDE assessment?
- A - Stridor
- B - resp distress (RR >60)
- C - pale/mottled/blue, reduced skin turgor
- D - unresponsive, won’t stay awake
- E - Fever < 3 months, non-blanching rash/neck stiffness
What are regarded as serious causes of fever in a child?
- Meningitis
- Surgical abdomen
- UTI
- Septic arthritis/osteomyelitis
- Pneumonia
