fever Flashcards
(35 cards)
fever in under 5s - assessment
CAST your magic spell on the kid:
Consciousness
ABCDE and take obs + CRT
Sepsis?
Traffic light - CAR-CHO (colour, activity, resp, circulation, hydration, other symptoms)
BP = a late sign
red flags of fever in under 5s
Colour - skin / mouth
Activity - responding poorly or cry high, weak or continuous
Fontanelle bulging
Skin turgor reduced
CAFS
serious differentials for fever in under 5s
Meningitis UTI Septic arthritis/osteomyelitis Kawasaki Sepsis
MUSKS
bacterial meningitis - presentation in <5s
bulging fontanelle
seizures
decreased LOC
neck stiff
pneumonia <5s - presentation + investigations
cyanosis + low sats
tachypnoea + work of breathing
crackles
obs
few tests are useful/required - CXR not routine in OP, bloods/cultures/sputum have little use
UTI <5s - presentation
fever + lethargy vomiting + poor feeding irritability abdo pain/tender urinary frequency/pain
UTI in <5s - investigation
urinalysis (clean catch/collection pads/catheter/suprapubic aspirate) - leucocyte esterase + nitrites
± MC+S if serious
kawasaki in <5s - criteria
fever > 38 ° > 5d + 4 of:
cervical lymphadenopathy red cracked lips, tongue, pharynx peeling, oedematous, erythematous palms/soles rash - polymorphous bilateral conjunctival injection
CRP-RB
fever in <5s - advice to + safety netting parents
advice: lots fluids/milk stay off nursery check in night how to - examine dehydration + identify nb rash
safety net - return if:
concern / deterioration
fit or nb rash
fever >5d
UTI in <5s - management
admission:
admit as necessary (assess seriousness)
urgently admit if < 3mo
> 3mo:
oral cephalosporin - 3d lower, 7d upper
safety net:
return if ill after 1-2d
fever of unknown origin - things to ask about
Meningism - headache, photophobia, neck stiff, rash
Activity - cry + responsiveness
Joint pains
Skin - rash, bruising, bleeding
Airway - coughs, colds + SOB
Tummy - diarrhoea, vomiting, pain
MAJ (MAJor 3 red flags first)
SAT (they’re sat down cos ill)
HSP - presentation
often follows resp infection
± intussusception
palpable purpuric rash - buttocks + extensor surfaces colicky abdo pain haematuria + renal failure inflamed joints swollen testes
acute lymphocytic leukaemia - presentation
bone marrow failure:
anaemia - lethargy + pallor (incl mucous membranes)
neutropaenia - frequent / severe infections / sepsis
thrombocytopenia - bruising + petechiae
plus: lymphadenopathy hepatosplenomegaly testicular swelling bone pain - marrow infiltration
ITP - what is it? presentation?
immune thrombocytopaenia - immune-mediated reduction in platelet count
petechiae + purpura after a viral illness
± nosebleeds / other bleeding
measles - presentation
prodrome: irritable, conjunctivitis, fever
koplik spots
rash - ears to body
measles - investigations
IgM antibodies within a few days of rash onset
measles - mgmt
inform PHE
supportive
may admit if immunosuppressed
types of febrile convulsion
simple - <15m, generalised
complex - 15-30m, focal
status - >30m
febrile convulsion: how parents should manage at home? risk of happening again? when should you admit? can they have vaccinations?
advise parents: start timer + film it using rectal diazepam/buccal midazolam 999 if > 5 min no evidence for antipyrexials
first/complex seizure - admit
1 in 3 risk of another
vaccinations as normal
febrile convulsion - link to epilepsy
RFs - FH, complex seizure
2.5% risk if no RFs
50% if many RFs
kawasaki - management
high dose aspirin
IV IgG
echo - screen for coronary artery aneurysms
kawasaki - complications
coronary artery aneursyms
HSP - management + prognosis?
supportive - NSAIDs + bed rest
monitor renal function
steroids if bad
1/3 relapse
status epilepticus in kids - management
call senior
A - airway support if not patent B - high flow O2 C - assess for shock, gain IV access? D - buccal midazolam (disability = seizure) E - glucose, ?meningitis, ?ICP
2° - IV phenytoin
