Feverish Child in Community Flashcards
What should always be considered as a differential in patients with signs and symptoms of infection?
Sepsis
How would you safety net parents with children who present with potential infection?
Tell them about signs that indicate increased work of breathing:
- Tracheal tug
- Recession (using a lot of intercostal muscles)
- Increased respiratory rate
- Abdominal breathing
- Cyanosis
What are the features that suggest epiglottitis?
- Typical presentation is a 2-4 year old with short history of fever, irritability, dyspnoea, dysphonia and dysphagia.
- Pooling of oral secretions and drooling of saliva
- The child may be sitting forward, breathing carefully
What is the typical presentation of epiglottitis?
Due to the use of Haemophilius influenzae type B conjugated vaccine increases, the typical person presenting with epiglottitis is an adult rather than a child. Sore throat is the most prominent symptom in older children and adults.
What would lower threshold for admission to hospital?
Check medical record for anything that would indicate immunocompromise as that would lower threshold treatment and admission to hospital. A peritonsillar abscess or cellulitis on examination would need immediate admission.
Why should you consider epiglottis before examining a patients throat?
There is a rapidly progressive cellulitis of the epiglottis and adjacent structures that can abruptly and completely stop the airway. People with suspected epiglottitis should not have their throat examined unless there are facilities for an immediate intubation/tracheotomy because of the possibility of precipitating complete airway obstruction or cardiopulmonary arrest.
What is the centor criteria?
Validated for children >3 years:
- Presence of tonsillar exudate
- Presence of tender anterior cervical lymphadenopathy or lymphadenitis
- History of fever
- Absence of cough
What do the scores in the centor criteria mean?
- Score 3/4 = suggests bacterial infection (40-60%) chance - may need abx
- Score of 1/2 = unlikely to have infection (80%) chance - abx unlikely
- Consider 2-3 day delayed prescription or immediate abx for people with a sore throat and centor criteria 3/4
What are some important points for a throat infection (OSCE)?
- Always ask about signs of sepsis/meningitis
- Infections can be caused by different bugs. Abx only work against infections caused by bacteria.
- Viruses are a common cause of sore throat infections and abx don’t work against them, have to let the immune system fight it off.
- Certain criteria help determine if a person needs abx
- Cough without sore raised glands, and without pus on the tonsils, the infection is more likely due to a virus than a bacteria
- If due to virus, it means abx are unlikely to get rid of the infection quicker and they could cause side effects e.g. tummy upset
- There is no simple test to prove however that it is definitely viral so safety net and ask them to come back if symptoms don’t improve
- Using abx unnecessarily increases resistance, which can cause further harm to people and make it harder to treat infections
When should parents bring children back to the GP?
If they develop new symptoms, seem unwell in themselves, are unable to swallow, noisy breathing or reduced oral intake.
What are the features of acute group A streptococcal (GAS) pharyngitis/tonsillitis?
- Common in children/adolescents aged 5-15 years
- More common in winter (or early spring) in temperate climates
- Streptococcal infection suggested by fever >38.5
- Exudate on pharynx/tonsils
- Anterior neck lymphadenopathy
- Absent cough
- Scarlatiniform rash (appears as small, red papules, widespread, with sandpaper texture)
What is the average heart rate in a child based on age?
- <1 = 110-160bpm
- 1-2 = 100-150bpm
- 2-5 = 95-140bpm
- 5-12 = 80-120bpm
- > 12 = 60-100bpm
A HR of 60 or less in any child <5yrs would be an indication to start CPR if also poor perfusion, despite adequate oxygen and ventilation.
What are the signs and symptoms of meningococcal disease?
Non-blanching rash particularly with one or more of:
- an ill-looking child
- lesions >2mm in diameter
- CRT >/= 3 secs
- neck stiffness
- fever
What are the signs and symptoms of bacterial meningitis?
- Neck stiffness
- Bulging fontanelle
- Decreased level of consciousness
- Convulsive status epilepticus
What are the signs and symptoms of herpes simplex encephalitis?
- Focal neurological signs
- Focal seizures
- Decreased level of consciousness
