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Paeds - Systemic > Fever > Flashcards

Flashcards in Fever Deck (14):
1

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.

2

What are the conditions you must rule out in fever in a child?

1. Meningitis 
2. UTI/pyelonephritis 
3. Pneumonia 
4. Osteomyelitis 
5. Septic arthritis
6. Septicaemia

3

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)

4

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

5

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

6

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

7

When should an LP not be conducted?

- Impaired conscious state
- Focal neurological signs
- Haemodynamically unstable

8

What does a full sepsis work-up entail

FBE/film, blood culture, urine culture (SPA), LP ±  CXR

9

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

10

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)

11

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

12

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

13

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) 

14

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