Fever
Fever guideline
Fever without Clinical Focus = <3 week or <3 OPC. PUO = 3 weeks or 3 OPC
Hyperthermia (can be hypothermic) (34.5-35.5C + 38.5-41C yellow)
Normal = 36.6-37.9C
Fever = >38C
Hyperpyrexia = >40
Natural peak is early evening, trough early morning
DDx
Infection:
Drug
Risks
Daycare
Daycare/Preschool = 10/year
Causes
Viral EBV
Typical bacteria: pneumococcus, meningococcus, HiB
Atypical bacterial: legionella, mycoplasma, chlamydia
Atypical because present differently (aka walking pneumonia)
Age (need to cover for vaginal flora, deteriorate rapidly)
Toxic
Focus (well with focus only investigate focus)
Hx
Pain
Dysphagia
Dyspnoea
Vomiting
Neck stiffness/photophobia
Bulging fontanelle
Irritable
Recent travel
Sick contact
>3 days
HSV Hx
Ex
Toxic
Arousal
Breathing
Colour, circulation, cry (weak/hight)
Decreased fluids
Ix
16S rDNA PCR generic test for bacterial
18S rDNA PCR generic test for fungi
Temp >38
<3m/toxic - Bloods, urine, IVabs Admit ?CXR ?LP
- 'step by step' High risk = abnormal paediatric assessment triangle, <21d, leukocyturia, OR PCT >0.5ng/mL. Interm = CRP >20mg/L OR ANC >10,000/mm3. all no = low risk
Well - treat focus
No focus - urine
Urine neg - review following day
Senior advice if GP or represent
Serious / severe bacterial infection v Invasive Bacterial infection
Fever fact sheet
Water
Remove excess clothes, enough not to shiver
NO tepid sponging/fan > no sustained drop, vasoconstriction/shivering increases temperature
Antipyretic only if uncomfortable
Paracetamol
Ibuprofen if >6mo
Review if <6mo, unwell, rash, chronic disease, profound lethargy
Complications:
Febrile convulsion - speed of increase, not height, antipyretic don't help
Shock > organ failure > death
Fever without Clinical Focus = <3 week or <3 OPC. PUO = 3 weeks or 3 OPC
Hyperthermia (can be hypothermic) (34.5-35.5C + 38.5-41C yellow)
Normal = 36.6-37.9C
Fever = >38C
Hyperpyrexia = >40
Natural peak is early evening, trough early morning
DDx
Infection:
- Pneumonia
- Meningitis - Meningococcal (leg pain!, cold extremities)
- UTI
Drug
Risks
Daycare
Daycare/Preschool = 10/year
Causes
Viral EBV
Typical bacteria: pneumococcus, meningococcus, HiB
Atypical bacterial: legionella, mycoplasma, chlamydia
Atypical because present differently (aka walking pneumonia)
Age (need to cover for vaginal flora, deteriorate rapidly)
Toxic
Focus (well with focus only investigate focus)
Hx
Pain
Dysphagia
Dyspnoea
Vomiting
Neck stiffness/photophobia
Bulging fontanelle
Irritable
Recent travel
Sick contact
>3 days
HSV Hx
Ex
Toxic
Arousal
Breathing
Colour, circulation, cry (weak/hight)
Decreased fluids
Ix
16S rDNA PCR generic test for bacterial
18S rDNA PCR generic test for fungi
Temp >38
<3m/toxic - Bloods, urine, IVabs Admit ?CXR ?LP
- 'step by step' High risk = abnormal paediatric assessment triangle, <21d, leukocyturia, OR PCT >0.5ng/mL. Interm = CRP >20mg/L OR ANC >10,000/mm3. all no = low risk
Well - treat focus
No focus - urine
Urine neg - review following day
Senior advice if GP or represent
Serious / severe bacterial infection v Invasive Bacterial infection
Fever fact sheet
Water
Remove excess clothes, enough not to shiver
NO tepid sponging/fan > no sustained drop, vasoconstriction/shivering increases temperature
Antipyretic only if uncomfortable
Paracetamol
Ibuprofen if >6mo
Review if <6mo, unwell, rash, chronic disease, profound lethargy
Complications:
Febrile convulsion - speed of increase, not height, antipyretic don't help
Shock > organ failure > death