Fever Flashcards
What are different ways to check temperature, and what is considered a fever for each? Which is GS?
- Axillary:
○ >37.2degrees
○ lower than other sites. Most accurate over axillary artery.
○ Usually used > 1mo - Oral:
○ >37.5 degrees - Rectal - GS:
○ >38 degrees
○ Usually <1mo - Skin: forehead/axilla. Ambient temp may affect reading.
What are the conditions you must rule out in fever in a child?
- Meningitis
- UTI/pyelonephritis
- Pneumonia
- Osteomyelitis
- Septic arthritis
- Septicaemia
What is the risk of a serious bacterial infection in children <3 months with fever?
Risk is 20-30% in <3 months (cf 1.3% 3-12mo)
Outline properties of low risk (green light) fever in children:
- Colour
- Activity
- Respiratory
- Hydration
- Normal colour
- Normal activity: responds to social cues, smiles, awake/awakens quickly, strong cry/not crying
- No amber/red resp signs
- Hydration ok
Outline properties of mod risk (amber light) fever in children:
- Colour
- Activity
- Respiratory
- Hydration
- Other signs
- Pallor
- Abnormal activity: not responding normally, no smile, wakes with prolonged stimulation, dec activity
- Resp: nasal flaring, tachypnoea (6-12mo >50, >12mo >40), <95% O2sat, crackles
- Hydration: reduced urine output, CRT >3s, poor feeding, dry mucous membranes
- Other:
○ fever >/= 5 days
○ limb/joint swelling
○ NWB/not using a limb
○ new lump >2cm
Outline properties of high risk (red light) fever in children:
- Colour
- Activity
- Respiratory
- Hydration
- Other signs
- Pallor/ashen/mottled/blue
- Abnormal activity: not responding normally, doesn’t wake/can’t stay awake, weak cry
- Resp: grunting, tachypnoea > 60 RR, chest indrawing
- Hydration: reduced skin turgor
- Other:
○ 0-3mo: T>38, 3-6mo: T>39
○ Non-blanching rash
○ Bulging fontanelle
○ Neck stiffness
○ Status epilepticus/focal seizures/neuro signs
○ Bile-stained vomiting
When should an LP not be conducted?
- Impaired conscious state
- Focal neurological signs
- Haemodynamically unstable
What does a full sepsis work-up entail
FBE/film, blood culture, urine culture (SPA), LP ± CXR
Outline Mx for fever <1mo (corrected)/<3.5kg
- Full sepsis work-up: FBE/film, blood culture, urine culture (SPA), LP ± CXR
- Admit for empirical antibiotics
Outline Mx for fever 1-3mo
- Full sepsis workup: FBE/film, blood culture, urine culture (SPA) ± CXR (only if respiratory symptoms or signs) ± LP
- Also: VBG, UEC
• D/C home with review within 12 hours if the child is: ○ Previously healthy ○ Looks well ○ WCC 5,000- 15,000 ○ Urine microscopy clear ○ CXR (if taken) clear ○ CSF (if taken) negative
• If not: admit to hospital for observation +/- empiric i.v. antibiotics (flucloxacillin and gentamicin)
Outline Mx for fever >3mo (corrected) with clear focus of infection
- if child looks well, treat as indicated
- if unwell, admit for Tx and Ix appropriately
Outline Mx for fever >3mo (corrected) with NO clear focus of infection
child looks well:
• If < 12 mo boys or <2 yrs girls -urine (SPA up to 12mo, >12mo mcs)
• Discharge home on symptomatic treatment
• Arrange medical review within 24 hr, or sooner if deteriorates
child looks miserable but is still relatively alert, interactive and responsive
• If < 12 mo boys or <2 yrs girls -urine (SPA up to 12mo, >12mo mcs)
• Ix
child looks unwell:
• Full sepsis workup: FBE, blood culture, urine culture ± CXR (if respiratory symptoms or signs) ± LP
• Admit to hospital for observation +/- i.v. antibiotics
When should we treat fever with paracetamol?
High temperature is not a good reason to treat fever unless prolonged and very high (> 40.5°C)
What are some general measures for managing a fever at home? Advice for parents?
- Encourage fluid intake
- Cool kid down
○ Dress lightly
○ Tepid sponge on forehead only - Don’t treat fever
- Return if worried
