Tots Too Hot : The Good, The Bad and the Ugly of Pediatric Fever

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Title: Tots “Too Hot!” - The Cute, The Bad and The Ugly of Pediatric Fever …

Title: Tots “Too Hot!” - The Cute, The Bad and The Ugly of Pediatric Fever

Description: Elevated temperatures in pediatric patients are some of the most common, and often frustrating types of calls in EMS. Are the parents over-reacting? Are we under-reacting? This presentation illuminates what causes fever, how it can help or harm a child, what problems it can cause or be caused by, how to differentiate critical vs benign fever and how to prioritize care in pediatric patients with elevated temperature.

Teaching Formats:
-Lecture
-Discussion
-Question and Answer

Learning Objectives: Students will learn:
- Normal and abnormal thermoregulation in pediatric patients.
- Obtaining accurate thermometry through a variety of methods.
- Differentiation of exogenous vs endogenous pyrogens.
- Differentiation of “Febrile Seizure” and “Seizure with Fever”
- Special concerns for pediatric fever including patients with sickle cell disease, poor cardiac reserves, poor respiratory function and immune-compromised or immuno-suppressed patients.

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  • How do they deal with Fever in the ED? Immediate Tylenol. Why? Comfort.Can Fever Fry the Brain? No, damage caused by infection.
  • What's one of the first things they do in the ED? TEMPWhat do they do when they find almost any fever? TYLENOLHigh med low temp has little connection to the origin or outcome of the infection.
  • Temps of 98.6 or 104 is a myth. Changes with circadian rhythms. Lowest in AM and highest in early evening.
  • If there is a history of cardiac illness or new cardiac murmur  or shock due to sepsis, then the child under 1 month should receive a 10 ml/kg/doseSepsis and Meningitis approx 1% but with significant Morbidity & MortalityIncomplete defense & immunizationsChildren < 3 months of age. Even if acting normal. (as they are immunologically immature and incompletely vaccinated)Kids under 90 days old may have upper limit of 104, not 107.Almost half of neonatal deaths are caused by sepsis, although advances in diagnosis and treatment have caused this rate to decrease substantially, especially in preterm infants
  • Cold hands and feet, limb pain, and pale or mottled skin are considered "red flag" manifestations of septicemia.
  • If they're sick, then you're increasing O2 demands. If they're not, then why are we cooling them?
  • Mixing & Matching & OD’ing
  • 20cc/kgIf there is a history of cardiac illness or new cardiac murmur  or shock due to sepsis, then the child under 1 month should receive a 10 ml/kg/dose
  • Clouds?A rainbow?A booger?

Transcript

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  • 20. QUICK Not QUICK
  • 21. Tone Interactiveness Consolability Look/gaze Speech/cry
  • 22. Work Abnormal Sounds Retractions Extreme Nasal Flaring
  • 23. Temperature - Skin Time - Capillary Refill Pulse
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