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CC March 2016 Evaluation of the Febrile Child

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echoecho's version from 2016-05-16 18:15

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Question Answer
Why has the evaluation and management of febrile illness in children < 36 months of age have posed a diagnostic dilemma? 1) because fever may represent the only manifestation of a significant illness and care must be taken not to ignore a potentially serious infection 2) considerable potential morbidity is associated with a full diagnostic workup, including parental anxiety
The wide use of effective vaccinations against what diseases that causes significant febrile illness has reduced the incidence of these infections by ___% and ____% respectively, since the 1990s?1) Haemophilus influenzae type B 2) Streptococcus pneumoniae 3) 99%; 77%
Even in under-immunized children, rates have decreased due to ____ immunity?herd
In children < 3 months of age, what infection are the most common cause of significant fever?UTI
Between 3 and 36 months of age, what is the most common cause of significant fever? pneumonia
Does teething produce a significant fever?no
Define fever?a rectal temperature > 38 C (100.4 F)
In children does axillary temperatures agree sufficiently with rectal temperature measurements to provide clinically accurate information?no
Ear temperatures are NOT accurate before ____ months of age?6
While an axillary temp may be used for screening, a temperature > ____ F should be rechecked with a rectal temperature in an infant < ____ months of age?3
What is the most accurate way to take the temperature in newborns up through age _____ years?4
After that age of 4, are oral temperatures accurate?yes
What physical exam findings could provide clues to the presence of a serious illness?1) drowsiness 2) inconsolability 3) cyanosis 3) crackles 4) poor peripheral circulation 5) tachypnea 6) hypotension 7) seizures or petechial rash
Lab work-up is based upon what?age
*** All febrile children < _____ days of age should be admitted to the hospital?29
What work-up for a febrile child < 29 days of age should include what?CBC-D, blood culture, UA, urine culture, lumbar puncture, CXR
If diarrhea is present, what should be obtained for a febrile child < 29 days old?stool culture, stool WBC
In a febrile child < 29 years old, what shohuld be started after cultures have are obtained?empiric antibiotics
List the empiric antibiotics for a febrile child who is < 29 days old?Ampicillin (100-200 mg/kg/day IV divided every 6 hours AND Gentamicin (2.5 mg/kg IV every 8 hours). If after 48-72 hours the child is afebrile, clinically improved and the results of all cultures show no growth, the child may be safely discharged from the hospital with no further antimicrobai therapy. If a source is identified, treatment should be tailored as indicated
*** Children between 29 days of age to 36 months with signs of serious illness who have fever should receive what?lab analysis based upon age
For a child 29 days - 36 months, what labs should be done?1) CBC-D (all) 2) UA C & S (1-24 months) 3) lumbar puncture (1-3 months and older children with neurological s/s or meningeal signs) 4) stool culture (only ifdiarrhea is present 5) CXR (respiratory s/s or if temp is > 39 C (102.2 F)
For a child 29 days - 36 months, what antibiotics should be used for suspected meningitis??Once cultures have been obtained, start Ceftriaxone (Rocephin) 50 mg/kg/day IV every 12-24 hours if meningitis is NOT suspected . 100 mg/kg/day if meningtis is suspectedngitis
For a child 29 days - 36 months, what antibiotics should be used for presumed UTI?Cefotaxime (Claforan) 50 mg/kg IV q 8 hours
For a child 29 days - 36 months, what antibiotics should be used for presumed pneumonia?Aithromycin (Zithromax) 10 mg/kg orally on day 1 and 5 mg/kg orally on days 2-5 OR Amoxicillin (Amoxil) 80 mg/kg/day every 8-12 hours
*** For children ages 29 days to 36 months WITHOUT serious illness, what lab work is drawn?CBC-D (1-3 months of age only); UA and UA C&S (1-24 months only); lumbar puncture (1-3 months only if WBC < 5000 or > 15,000, stool culture (if diarrhea is present); CXR (respiratory symptoms or if temp is > 39 C (102.2 F)
For a children ages 29 days to 36 months WITHOUT serious illness, what empiric antibiotics is used?1) Ceftriaxone 2) Cefotaxime (if UTI is suspected) and 3) Amoxiicilin (if resp s/s are present)
*** For a child age 29 days to 36 months = If good outpatient follow-up is available, patients can be sent home with parents with close follow-up; if follow-up is questionable, what should be done?admitted for work-up and empiric treatment
What testing may be considered in febrile neonates who were monitored with fetal scalp electrodes, infants with seizures, when leukocytosis is present in the cerebral spinal fluid or when HSV lesions are present?Herpes simplex virus (HSV)
What is the tratment for a patient with herpes simple?Acyclovir (60 mg/kg day IV in 3 divided doses)
What testing is done during influenza season?influenza
Studies have shown that it is uncommon for children to have a significant ______ infection if they test positive for influenza?bacterial
In contrast, children who test positive for what still have a significant risk for UTI?RSV (respiratory syncytial virus)
*** SUMMARY = In children < 3 months of age, what infections are the most common cause of significant fever? In children between 3-36 months of age, what is the most common cause of significant fever?UTI; pneumonia
*** SUMMARY = What type of temperature is the most accurate way to take the temp in a newborn and children up to age 4 years?rectal
*** SUMMARY = Evaluation of the febrile child depends on 2 conditions, list these?1) child's age 2) whether there are signs of serious illness
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