Cough and Cold: Fever, Sore Throat, Rhinorrhea Flashcards

1
Q

Cough and Cold

Fever

What are the symptoms, definition and the cause of the fever?

A

Symptoms - headache, backache, malgia, arthralgia, somnolence, chills and rigors
Definition - temperature consistently over 38 c
Cause - infection

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2
Q

Cough and Cold

Fever

What is the major substance producing
an elevation of the thermoregulatory set‐point?

A

Prostaglandin E2, released by the hypothalamus

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3
Q

Cough and Cold

Fever

What ages may not mount an elevated
temperature in the presence of serious illness?

A

Children <3 months of age and older adults (≥65 years of age)

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4
Q

Cough and Cold

Fever - Febrile Seizure

Who and when febrile seizure happen?

A

When a young child has a fever above 38°C (not considered epilepsy)

Most children outgrow having febrile seizures by the time they are 5 years old

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5
Q

Cough and Cold

Fever - Febrile Seizure

What are the causes?

A

Unknown?

Some evidence suggests that they’re linked to some viruses and the way that a child’s developing brain reacts to high fevers

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6
Q

Cough and Cold

Fever - Febrile Seizure

What are the presentations?

A
  • Few minutes up to 15 minutes
  • Convulse, shake, and twitch all over
  • Roll the eyes
  • Moan
  • Become unconscious (pass out)
  • Vomit or urinate (pee) during the convulsion
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7
Q

Cough and Cold

Fever - Febrile Seizure

How to manage?

A

◦ Treating child with fever medication will NOT
prevent or shorten a febrile seizure
◦ Acetaminophen, ibuprofen to keep child
comfortable a seizure or shorten it’s duration
◦ Gently place your child on the floor or the ground
◦ Remove any nearby objects
◦ Place child on his or her side to prevent choking
◦ Loosen any clothing around the head and neck.
◦ Watch for signs of breathing problems, including
bluish color in the face.
◦ Try to keep track of how long the seizure lasts
◦ Call paediatrician or family doctor for follow‐up

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8
Q

Cough and Cold

Fever - Febrile Seizure

When to call 911?

A

If the seizure lasts more than 3 minutes, or child

turns blue, more than one seizure in 24 hrs

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9
Q

Cough and Cold

Fever Meaurement

What are the anatomic sites to measure fevers?

A

Oral, rectal, axillary, temporal artery, tympanic membrane and transcutaneous routes all approximate
temperature

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10
Q

Cough and Cold

Fever Measurement

What is the gold standard for Children ≤ 5 years of age?

A

rectal thermometry

BUT can use other methods:
- Tympanic temperature measurement in children ≥2
years of age and axillary temperature measurement
in children of all ages

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11
Q

Cough and Cold

Fever Measurement

What is recommended for Children >5 years of age and adults?

A

oral thermometry

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12
Q

Cough and Cold

Fever Assessment Red Flags:

In a patient presenting with fever, what are the red flags for referring patient to the emergency immediately?

A
  • age < 3 months
  • presence of stiff neck, seizure, localized pain,
    redness, swelling or heat
  • new wheeze/cough
  • recent cancer therapy, e.g., chemotherapy
  • In children, appearing very ill, excessively fussy,
    irritable, crying inconsolably or other symptom(s)
    worrying the patient
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13
Q

Cough and Cold

Fever Assessment Red Flags:

Additional red flags to assess?
refer for immediate examination by physician/urgent care

see chart for more

A
  • age < 6 months
  • fever > 40.5 C
  • persistent wheeze/cough
  • new onset rash and fever
  • difficult to rouse, confused or delirious
  • presence of serious underlying illness
  • recent surgery or dental procedure
  • recent travel
  • recent consumption of raw or undercooked meat or fish
  • recent initiation of new medication
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14
Q

Cough and Cold

Fever
Non-pharm management

A
  • removal of excess clothing, bedding, increase fluid intake
  • ambient temp set at 20-21 C, avoidance of physical exertion
  • heating pad for earache, cold drink for sore throat
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15
Q

Cough and Cold

Fever
Pharm management

A

Antipyretics decrease prostaglandin synthesis in the brain and reducing the thermoregulatory set‐point

Acetaminophen, ASA, ibuprofen and naproxen sodium
◦ No naproxen or ASA in children!
◦ Short term use and administered at regular intervals
◦ Insufficient evidence for alternating acetaminophen and ibuprofen administration to reduce fever

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16
Q

Cough and Cold

Sore throat

when do initial symptoms present?
diff diagnosis? (4 classic symptoms)

A

over days 1 to 3

Differential diagnosis: strep throat
4 classic symptoms
◦ Tonsillar swelling/exudate
◦ Swollen anterior cervical nodes
◦ Fever >38C
◦ LACK OF COUGH
17
Q

Cough and Cold

Sore throat

Pharm management (3)

A

Analgesics
◦ Acetaminophen, NSAIDs

Lozenges and anesthetic sprays – use every 3‐4 hrs prn (Allow to dissolve slowly)

  • Benzocaine (Cepacol)
  • Dyclonine (Sucrets)
  • Hexylresorcinol (Bradosol)
  • Phenol (Chloraseptic spray)

Menthol
◦ Stimulates “cold” receptors, counterirritant effect

18
Q

Cough and Cold

Sore throat

non-pharm management (3)

A
  • Saline gargle: 1⁄4 tsp salt in 1⁄2 cup water
  • Ice chips
  • Hard candies
  • Fruit juices
  • Citrus irritates the mucous membrane – creates natural demulcent (form protective film to relieve irritation of mucus membranes)
19
Q

Cough and Cold

Rhinorrhea
drugs that cause runny/stuffy nose

A

• clear discharge to thicker more purulent secretions

ACEi
B‐Blockers
Chlorpromazine
Cocaine
Estrogen
Methyldopa
NSAIDs
20
Q

Cough and Cold

Rhinorrhea

pharm management

A

often part of combo pdts
- anticholinergic or antihistamine agents
◦ Intranasal ipratropium blocks cholinergic‐ mediated vasodilatation

◦ anticholinergic effects of some first‐ generation antihistamines

  • postnasal drip, makes mucus thicker
  • side fx outweigh benefits
  • 2nd gen aren’t effective, lack antichol fx
21
Q

Cough and Cold

Rhinorrhea

Antihistamine pdts
READ

A

Dex/Brompheniramine (Dimetapp, Dimetane, Drixoral)

Chlorpheniramine* (Advil Allergy and Sinus, Triaminic, Tylenol Cough and Cold)

Diphenhydramine* (Benylin, Buckley’s Nighttime)

Doxylamine (Vicks Nyquil, Tylenol Cold and Flu Nighttime)

Pheniramine (NeoCitran, Robitussin AC)

Pyrilamine (Jack and Jill Cough, Hycomine)