FEVER Flashcards
(59 cards)
1
Q
What is a massive red flag
A
Fever >5 days
2
Q
What does it suggest
A
Malignancy
3
Q
What are common organisms in neonates
A
Group B strep
E.coli
Listeria monocytogenes
HSV / VZV = high mortlality
4
Q
What are common organisms in children
A
S.pneumonia H.influenza Meningococcal Strep A S.aureus
5
Q
What are non infectious causes of fever
A
Kasawaki JIA SLE Leukaemia / lymphoma Neuroblastoma Medication
6
Q
What are symptoms of sepsis / unwell child
A
Fever Rigors Hypothermia Hypoglycaemia D+V Rash Shock DIC Dehydration
7
Q
What suggests dehydration
A
Low BP Increased CRT Increased RR + HR Cool periphery Sunken fontanelle Dry mouth Decreased urine output Skin turgor
8
Q
What suggests altered mental status
A
Lethargy Irritable Floppy Seizure Decreased GCS
9
Q
What suggests poor perfusion
A
Long CRT Cold periphery Cold Mottled Pale Cyanosed Decreased urine
10
Q
What suggests septic shock
A
Tachycardia Tachypnoea Poor perfusion Altered mental CRT >4s Cool periphery Decreased urine BE <5 Agitated / drowsy Hypotension = very late sign - Child can be normotensive and very ill
11
Q
What are amber signs requiring further assessment / safety net / senior advice / observation
A
3-6 months
Colour
Pallor
Activity No smile Not responding to social cues Decreased activity Will wake with prolonged stimulation Poor feeding
Resp Nasal flaring RR >50 - THINK SEPSIS / ACIDOSIS Sats <94 Crackles
Circulation Tachycardia - Difficult due to anxiety / crying CRT >3s Dry membrane Decreased urine - Wet nappy suggest hydrated
Other
Rigors
Fever >5 days
12
Q
What are red flags = urgent assessment and senior support
A
Colour
Mottled
Cyanosed
Activity No response Appear ill Not awake High pitched weak cry - Suggest meningeal irritation Continuous cry
Resp
RR >60
Recessions / undraping
Grunting
Circulation
Reduced turgor
Other <3 month If <1 month will get full work up with culture and LP even if look well Rash non-blanching Bulging fntanelle Stiff neck Seizure / status Focal neuro
13
Q
What are special circumstances where child should always be referred
A
<3 months
Immunocompromised - post chemo / steroids
Fever >5 days
14
Q
What should be done for a child with fever of unknown origin
A
Bloods
Blood culture
Imaging
15
Q
When is it not needed
A
If source of fever known
16
Q
What bloods
A
FBC Film U+E LFT CRP Coag X match Glucose Ca, Mg Blood gas
17
Q
What bloods are part of full septic
A
FBC for WCC U+E Coag for DIC CRP - rise faster in infection ESR - rise faster in AI Glucose Blood gas
18
Q
What should you culture
A
Relevant to Hx Blood Throat Urine Stool if diarrhoea CSF Skin / wound NPA - Helpful for viral bronchiolitis to prove RSV
19
Q
What cultures if doing full septic
A
Blood
Urine
CSF
Throat
20
Q
What imaging should be done in full septcic
A
CXR
21
Q
What other imaging and what should be done to show end organ
A
Abdo USS
Limb X-Ray
CT / MRI
ECHO
U+E
LFT
Bone profile
22
Q
When should a child get a full septic screen + LP if present with fever (even if well)
A
<3 months
Immunocompromised
>5 days
23
Q
What should you do if child >3 months + red flags
A
FBC
Blood culture
CRP
Urine
24
Q
What should you do if no features serious illness
A
Urine dip
Assess for pneumonia
25
What should you record in all children
```
Temp
HR
RR
CRT
Signs of dehydration
```
26
How do you treat child with fever if admitted
Monitor and observe
```
Anti-pyretic
- Paracetamol
- Ibuprofen
Encourage fluid
Can give ORS if dehydrated
```
Ax / sepsis 6 if appropriate
O2 if <92%
20ml / kg bolus saline if shock
Inotropic support if no improvement
27
What do you do for <3 months with fever
Admit for assessment
Full septic screen as fever may be only Sx of severe illness
LP when stable
28
What Ax to neonate and <3 months
Gent and benpen to neonate
Ceftriaxone and amox
Aciclovir
29
What do you do for immunocompromised
Specific policy
30
When would you give IV Ax
<1 +-
Impaired consciousness +-
Shock +-
Signs of meningococcal +-
31
What do you do if you suspect encephalitis
IV Aciclovir
32
How do you safety net
```
Open access
Give regular fluid
Check child at night
Blood in stool
Signs of dehydration
Non-blanching rash
Contact If get worried or fever >5days
```
33
Should you ever prescribe Ax without a source
NO
34
What are CI to LP
```
Raised ICP
-Focal neuro
-Papilloedema
-Bulging fontnelle
DIC
Cerebral herniation
Meningococcal septicaemia
```
35
What is important in the history of fever / any unwell child
Do they require urgent intervention
- ABCDE
- PEWS / vital signs
- Do they appear well or sick - according to person
```
General
Onset, duration, progression, variation
Systemic symptoms
Urine?
Bowel?
E+D?
Any rash / skin change?
Activity?
Crying?
FTT
```
```
Specific
Resp Sx - apnoea / grunt / distress / same as adult
ENT - sore throat / ears / discharge
GI - D+V / pain
Urinary - pain / freq / nocturia / change colour or smell
CVS - FTT / sweat / poor feed
Neuro - behaviour
Derm - skin change
Ortho - limp / not using
```
```
Other
RF
Contacts
Vaccination Hx
Recent travel
PMH
- Underlying disease
- Medications
```
36
How do you examine a child with fever
```
ABCDE
If unstable = anaesthesistist
PEWS / Vitals (temp, HR, RR, CRT, BP, sats)
Respiratory - wheeze, effort, added sounds
CVS - murmur, perfusion, dehydration
Abdomen - tender? distension?
Rash
Nodes
ENT
```
37
What causes persistent fever
```
Malignancy
Kawasaki
HSP
Endocarditis
UTI
Aspecific viral = common
```
38
What is a maculopapular rash
Red bumps on flat red skin
Macules + papules
BLANCH
39
What causes maculopapular rash
```
Viral
Early meningococcus so beware
Drugs
Enterovirus
Parovirus
EBV
CMV
HIV
Measles
```
40
What is a purpuric rash
Petechiae >2cm
| NO BLANCH
41
What causes purpuric rash
```
Meningococcal
HSP
ITP
Enterovirus
Rubella
CMV
TORCH
Trauma
```
42
What causes vesicobullous rash
Enterovirus
HSV
VZV
43
Why should a child with joint swelling / non weight bear <3 be referred
More likely SA / trauma
44
What should child with green symptoms
Treated at home
| Safety net
45
When do you really worry with fever
<1 month
| Full septic screen
46
What is a fever
Elevation exceeding normal
>37.5 = low grade
>38 = fever
Does not predict severity
47
What is fever with no focus
Common in first 48 hours as illness may not have progressed
| More investigation need
48
What is prolonged
Longer than expected for disease
| e.g. GI 10 days or EBV 3 weeks
49
Fever unknown origin
>3 weeks with no cause identified
50
What is early onset sepsis
Neonatal - 48 hours
| Usually GBS etc
51
What is late onset
48 hours to one month
| Can be from mother or environment
52
What is neutropenic
<1 neutrophils but temp >38
53
When is a fever not always present
Newborn
Immunocompromsied
Steroid
More vulnerable and show less signs so low threshold for Ax
54
What does fever do
```
Increase BMR
- Weight loss if chronic
Increase insensible
- Increase fluid requirement
Increased HR
- Sepsis vs response of fever
```
55
What causes fever
Pyogene from infection / inflammation. / malignancy release cytokines and change core temp at hypothalamus
56
What is Multi-System Inflammatory Syndrome
```
Fever >3 days
Hypo / shock / myocardial dysfunction / coagulopathy / GI upset
Raised inflammatory
- CRP / ESR / proclacitonin
Evidence of COVID contact
No other cause
```
57
What should you write in notes
What you think it is
No signs of
- Conditions you don't want to miss
58
What conditions
SEPSIS
Other serous bacterial.- meningitis / pneumonia / UTI
Leukaemia
SA etc.
59
What are options
Send home with safety net
Admit for observation
Admit for screen
