Feverish Child Flashcards
(36 cards)
What is a likely diagnoses from the video?
Meningococcal disease
Meningitis
How urgent is this situation?
Emergency
What are the causes of meningitis?
Neissaria meningitis
Streptoccocus pneumoniae
Haemphilius influenzae
What is meningitis?
Infection of the protective membranes that surround the brain and spinal cord (meninges)
Most common in babies, young children, teenagers and young adults
Can cause life-threatening blood poisoning (septicaemia) and result in permanent damage to the brain or nerves
What are the sign and symptoms of meningitis?
Fever Vomiting Headache Non-blanching rash Altered mental state
Photophobia
Kernig’s sign
Brudzinski’s sign
What are the sign and symptoms of meningococcal disease?
Fever Vomiting Headache Non-blanching rash Altered mental state
What are the sign and symptoms of septicaemia?
Fever Vomiting Headache Non-blanching rash Altered mental state
Shock
Hypotension
Increased cap refill
Cold
What is Kernig’s sign?
Kernig’s sign is performed with the individual lying on their back with their hips and knees bent. The clinician will then slowly attempt to straighten the leg. If pain or resistance is felt, the Kernig’s sign is said to be positive
What is Brudinski’s sign?
Brudzinski’s sign is positive when passive forward flexion of the neck causes the patient to involuntarily raise his knees or hips in flexion
What is the management of suspected meningitis in primary care?
Organise immediate transfer to hospital by telephoning 999
Single dose of parenteral (IM/IV) benzylpenicillin asap, unless allergic
What do you do if there is a non-blanching rash?
Transfer without antibiotics
What would you do for the child in hosptial?
IV antibiotics ASAP
Fluids
Blood - PCR to look for nisseria
Lumbar puncture? but can be problematic if raised ICP
What are fontanelles?
Fontanelles are the soft spots on an infant’s head where the bony plates that make up the skull have not yet come together
Why do we do a lumbar puncture?
Look at WCC Check protein in CSF Glucose Gram staining Microbiological cultures
How do we judge if there is raised ICP?
CT is unreliable in judging raised ICP
Clinical assessment should be used
e.g. feeling fontanelles
What does bacterial CSF look like?
Turbid
Lots of protein
+ve gram staining in 60-90%
Raised pressure
What does viral CSF look like?
Clear
Not a lot of protein
Normal or raised pressure
What does fungal CSF look like?
Fibrin
Not a lot of protein
When calling the SpR anaesthetist what information would you want to convey?
Patient details - name, DOB, age, weight etc.
Current condition of the infant (stable/unstable), how urgently they need to be seen
Drug allergies
AMPLE
(Allergies, medication, past history, last meal, events)
What is considered a normal temperature?
36.5 - 37.2
lower in axilla
higher in ear
high temp = >38
What is important in the history from the parent?
how long? rash? blanching or non-blanching? abnormal crying? limb or join problems? vomiting or diarrhoea? travel? feeding? urine output?
What else is important to consider in the parental history?
Parental anxiety and instinct
Social and familial circumstances
Other illnesses affecting the child
How do you measure temperature in infants younger than 4 weeks?
Electronic in axilla
How do you measure temperature in a child between 4 weeks and 5 years?
Electronic in axilla, chemical dot in axilla or infrared tympanic
