GP ILA 2: Hot and Bothered Flashcards
Febrile child assessment, Antibiotic prescription Vaccination schedules
Sepsis definitions
a) Define sepsis
b) Define septic shock. What 3 measures of shock may be used.
c) Give the 4 SIRS criteria (2 or more needed)
d) Give the 3 qSOFA criteria (2 or more needed) - what is it used for?
a) Life-threatening organ dysfunction caused by a dysregulated host response to infection
b) A subset of sepsis in which underlying circulatory and cellular metabolism abnormalities are profound enough to substantially increase mortality. Hypotension, elevated lactate level, and a sustained need for vasopressor therapy.
c) Temperature >38°C or <36°C, Heart rate >90/min, Respiratory rate >20/min or Paco2 <32 mm Hg (4.3 kPa), White blood cell count >12 000/mm3 or <4000/mm3 or >10% immature bands
d) Altered mental status (GCS <15), Respiratory rate ≥22, Systolic BP ≤100. Used for predicting mortality in patients with suspected sepsis outside of ICU.
Recognising sepsis in adults.
SEPSIS
Slurred speech or confusion Extreme shivering or muscle pain Passing no urine (in a day) Severe breathlessness It feels like you’re going to die Skin mottled or discoloured
NICE traffic light guidance for assessing risk of serious illness in a feverish child under 5.
(CARChO)
Colour Activity Respiratory Circulation and hydration Other
NICE traffic light guidance: Colour
a) Green
b) Amber
c) Red (4 types)
a) Normal colour
b) Pallor reported by parent/carer
c) Pale/mottled/ashen/blue
NICE traffic light guidance: Activity
a) Green
b) Amber
c) Red (1 extra)
Mnemonic: CARS
a) Green: Cry (normal, strong or not crying), Awake (or awakens quickly), Responds (normally to social cues), Smiling (or content).
b) Amber: Not responding normally to social cues, No smile, Wakes only with prolonged stimulation, Decreased activity, No response to social cues
c) RED: Appears ill to a healthcare professional, Does not wake or if roused does not stay awake, Weak/high pitched/continuous cry
NICE traffic light guidance: Respiratory
a) Green (none)
b) Amber (4)
c) Red (3)
Rate, Oxygen, Signs of increased WOB
a)
b) Amber: Nasal flaring, Tachypnoea: RR (>50 breaths/minute if age 6–12 months; RR >40 breaths/minute if age >12 months), Oxygen saturation ≤95% in air, Crackles in the chest
c) RED: Grunting; Tachypnoea: RR >60 breaths/minute; Moderate or severe chest in-drawing
NICE traffic light guidance: Circulation and hydration
a) Green (2)
b) Amber (5)
c) Red (1)
a) Green: Normal skin and eyes; Moist mucous
membranes
b) Amber: Tachycardia: (>160 beats/minute if age <12 months; >150 beats/minute if age 12–24 months; >140 beats/minute if aged 2–5 years, CRT ≥3 seconds, Dry mucous membranes, Poor feeding in infants, Reduced urine output
c) RED: Reduced skin turgor
NICE traffic light guidance: Other
a) Green
b) Amber (2 MSK, 2 fever)
c) Red (1 skin, 5 neuro, 1 fever)
a) None of the red and amber signs
b) Amber: If age 3–6 months temperature ≥39°C, Fever for ≥5 days, Rigors, Swelling of a limb or joint, Non-weight bearing limb/not using an extremity
c) RED: If age <3 months temperature ≥38°C, Non blanching rash, Bulging fontanelle, Neck stiffness, Status epilepticus, Focal neurological signs, Focal seizures
Fever differentials in under 5s
a) Non-blanching rash, particularly with 1 or more of the following: an ill-looking child, CRT ≥3 , neck stiffness
b) Neck stiffness, Bulging fontanelle, Decreased level of consciousness, Convulsive status epilepticus
c) Focal neurological signs, Focal seizures, Decreased level of consciousness
d) Tachypnoea (respiratory rate >60 breaths/minute, age 0–5 months; >50 breaths/minute, age 6–12 months; >40 breaths/minute, age >12 months), Crackles in the chest, Nasal flaring, Chest in-drawing, Cyanosis, Oxygen saturation ≤95%
e) Vomiting, Poor feeding, Lethargy, Irritability, Abdominal pain or tenderness, Urinary frequency or dysuria
f) Swelling of a limb or joint, Not using an extremity, Non-weight bearing
g) Bilateral conjunctival injection, change in mucous membranes, change in the extremities, polymorphous rash, cervical lymphadenopathy
a) Meningococcal sepsis
b) Bacterial meningitis
c) HSV encephalitis
d) Pneumonia
e) UTI
f) Septic arthritis, JIA
g) Kawasaki
History of unwell child.
a) HPC
b) PMHx:
c) SHx:
a)
b)
c)
Green (low-risk) management:
a) General advice
b) Safety netting - seek further help if…? c) Can be managed at ____.
a) Regular fluids, analgesia, bed rest, how to detect signs of dehydration, check child during the night, keep child away from school while fever persists
b) Child is severely dehydrated, has a fit, develops a non-blanching rash, seems less well than when they previously sought advice, the parent or carer is more worried than when they previously sought advice, or concerned that they are unable to look after their child, or if the fever lasts longer than 5 days
the parent or carer is distressed
c) Home
Amber (intermediate risk) management:
a) Two options
b) Should also let the parents know how they may seek further help - 2 options.
a) provide parents or carers with a ‘safety net’ or refer to specialist paediatric care for further assessment
b) arranging further follow-up at a specified time and place or liaising with other healthcare professionals, including out-of-hours providers, to ensure direct access for the child if further assessment is required.
Red (high-risk) management:
a) If not immediately life-threatening, see HCP within ___ hours.
b) If life-threatening…?
a) Within 2 hours
b) Transfer to A and E; call 999
Notifiable diseases.
a) Who should be notified?
b) Do you notify on suspicion or diagnosis?
c) Time window: i) Normal, ii) Urgent
a) Local Health Protection team
b) Suspicion
c) 3 days; 24 hours
Immunisation schedule.
a) 6 in 1 vaccine - contents? age?
b) What causes whooping cough?
c) Other vaccines given in the first year
d) 4 in 1 pre-school booster
e) Around university age, immunity to what virus wears off in some? Can cause what?
f) HPV - age and schedule
g) Teenage booster (3 in 1)
h) What is given at 14 years and for new university students aged 19-25?
i) Give some other optional vaccines
j) Flu vaccine in kids
k) MMR vaccine schedule
a) Diphtheria, polio, pertussis, tetanus, Hib, Hep B; given at 8, 12 and 16 weeks
b) Bordetella pertussis
c) PCV, rotavirus, MMR, Men B, Men C/Hib
d) Diphtheria, tetanus, whooping cough and polio
e) Mumps: orchitis and infertility
f) 12-13 years as two injections at least six months apart
g) tetanus, diphtheria and polio
h) Men ACWY
i) FLU, chickenpox, BcG
j) Given annually as a nasal spray in Sept/Oct for all children aged two to eight years on 31 August 2017
k) 1 year and 3 years
