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 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
