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Flashcards in Fever in a child Deck (9)
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1
Q

What are the age groups, symptoms and signs you’d expect in someone with a febrile convulsion? What differentiates between simple and complex?

A
  • 6mths to 6 years of age.
  • <6mths rule out serious cause (meningitis).
  • 3% of healthy children (common)
  • Associated with viral infections and fever
  • Simple vs complex:
    • Simple (tonic clonic <15mins don’t recur in same illness)
    • Complex: odd beginning (focal signs), odd middle (longer than 15), odd end (incomplete recovery in 1 hr), odd again
2
Q

What adivce do you give to parents taking a child who has had a FC home?

A
  • Seizure at home
    • stay calm,
    • baby to just have it,
    • on a soft surface and lie supine.
    • Don’t put in water and don’t put anything in their mouth
  • When to call ambulance
    • Seizure longer than 5 mins
    • if you’re worried call the ambulance. Do not drive them into hospital. Drive safely when driving in the car (maybe if 2 adults).
    • Child unresponsive after
    • Looks really unwell.
  • Factsheet
  • F/U with GP
3
Q

What is the management of Febrile Convulsions in Hospital?

A
  • 5-10mins supportive care, right position, away from injurious agents
  • Adequate airway and breathing.
  • Persistent seizure, active management:
    • O2
    • IV access,
    • check glucose - BSL (easy to fix),
    • calcium (hypocalcemia is a cause - absent in Vit D deficiency), - easily treatable.
  • Benzodiazepines, 5 mins benzos , another 10 - phenytoin
  • Reassurance
  • Panadol for pain and discomfort. Doesn’t decrease risk of FC or reduce the fever, only for discomfort
  • Treat cause of the fever.
4
Q

Prognosis of FC? What is the change of getting epilepsy?

A
  • Low risk of neurological complications
  • Good prognosis for remisiion of FC, 50% risk of recurrence if 1 year old, 30% RRC in 2 years old.
  • If you have RFs then risk is different:
  • FHx of epilepsy
  • Neurodevelopmental problem
  • Atypical FC (prolonged or focal)
  • 1% for epilepsy in general population, 1 RF = 2% of epilepsy, more than 1 = 1 10% risk of epilepsy
  • Follow up visit
5
Q

What is the definition of febrile? How do you measure it?

A
  • >38 degrees rectally (closer to core body temp)
    • do rectal in neonates
    • 5-6 years don’t need it but less accurate tests:
      • tympanic
      • axilla
      • skin
      • patch on stomach
6
Q

Some broad categories of causes for fever, what associated features would you look for?

A
  • Infection (viral or bacterial)
  • Cancer (leukemia (<5), lymphoma)
  • Rheumatological
    • familial (mediterranean)
    • cyclical fever syndromes
    • IBS
    • Juvenile arthritis
  • Drug reactions
    • SSRI overdose

Rashes:

  • Purple nonblanching worried about meningococcal
  • petechiae
  • purpura
  • torso/arms
7
Q

What is the risk of serious bacterial infection in a 2 month old?

A
  • 7% have serious fever
  • 7% have infection if you look
  • rest are viral and well
8
Q

Talk through septic screening and conditions when you’d do it?

A
  • all babies go to the ED if >38 temp
    • Most get LP (esp if <3mths)
      • ratio of RBC to WBC
      • WCC
        • platelets and WCC up
        • leukocytosis bacterial
        • platelets are an acute phase reactant
    • FBE
    • CRP
    • film
    • glucose
    • UTI
    • blood culture
    • +/- CXR - recession

Summary:

  • <3mths always LP
  • >3mths +/- LP
9
Q

What is the treatment for a febrile child?

A
  • antibiotics - with no diagnosis you want to treat for sepsis (not meningitis)
    • febrile and unwell IV anitbiotics until you have a blood culture and no organism on urine
  • >2mths fluclox and 3rd gen cephalosporin
  • <2mths benz pen + 3rd gen cephalosporin
  • ceftriaxone in older children
  • if you’re worried about staphylococcus add flucloxacillin
    • e.g. umbilical cord