EMC lecture

1. EMET
Kids with Bugs Dr Ian Turner

2. Temperature
❖ >38C (rectal in under 3 months)
❖ Consider hypothermia
❖ Temp higher in evening

3. Where’s the fever from?
Bacteria
Streptococcal pharyngitis
Otitis media
Pneumonia
UTI
Cellulitis
Meningitis
Septic arthritis
Osteomyelitis

4. Where’s the fever from?
Viruses
RTIs
Pharyngitis
Gastroenteritis
Otitis media
Meningitis/encpehalitis

5. Where’s the fever from?
Non-infective
Malignancy
Auto-immune
Immunisations
Drugs
Environment
Thermometer

6. Age matters
❖ <1 month (neonate)
❖ 1-3 months (infant)
❖ <3 months - 17% UTI, 2% bacteraemia, 0.9% meningitis
❖ >3 month
❖ investigations and treatment affected

7. Neonate
❖ Bugs from mum
❖ GBS, E coli, Listeria, Haemophilus, HSV
❖ UTI, meningitis
❖ PROM, prematurity, multiple pregnancy, vaccinations
❖ Do the LP
❖ Refer to appropriate guidelines (eg. penicillin and gentamicin OR cefotaxime)
❖ Consider acyclovir

8. Infant
❖ Strep, Neisseria, Staph, Haemophilus, Salmonella, Shigella, HSV
❖ Do the LP if you suspect
❖ Refer to appropriate guidelines (eg. ceftriaxone, penicillin)
❖ Consider acyclovir
❖ Low risk - previously well, looks well, normal vitals, WCC 5-15, clear urine

9. 3 month to toddler
❖ Safer age group
❖ MSU minimum
❖ Clear site
❖ Well or unwell?
❖ Refer to appropriate guidelines (ceftriaxone, flucloxacillin)

10. Case 1
❖ Cooper, 7 months old, usually well
❖ 3 days of fever
❖ Seen by GP

11. Case 1
❖ 38.1C, RR 32, SaO2 99%, HR 160
❖ Alert, smiling, playing
❖ Nil focus found

12. Case 1
❖ Returns following day
❖ Fevers resolved
❖ But mum very worried about new rash

13. Case 2
❖ Isabella, 4 years old
❖ ALL age 13 months
❖ Coughing for 3 days
❖ Now has fever and rash

14. Case 2
❖ Supportive care
❖ Seek and treat complications
❖ Contacts

15. Case 3
❖ Patrick, 5 years old
❖ Fever and limp for 3 days
❖ Now cannot walk
❖ Carried into department by dad

16. Case 3
❖ No trauma or recent URTI
❖ No hip problems when younger
❖ Looks unwell
❖ 38.9C, HR 127, BP 100/80, RR 20, SaO2
99%
❖ Refuses examination of legs - not
deformed, swelling and redness around
knee

17. Case 3
❖ Analgesia
❖ Bloods
❖ Imaging
❖ Antibiotics - ?which bugs

18. Case 4
❖ Olivia, 7 months, 2/7 cough and fever
❖ Not drinking as much
❖ Video

19. Case 5
❖ Ava, 2 years old, noisy breathing
❖ Dad and mum concerned there is a family
history of asthma
❖ Video

20. Case 5
❖ How severe?
❖ Treatment options
❖ When to transfer?

21. Case 6
❖ Ava represents the following night with
worsening breathing and fever
❖ Minimal oral intake all day
❖ 40.1C, RR 46, SaO2 94%, HR 175, BP
98/64
❖ Sitting forward on mum’s lap

22. Case 6
❖ How does your management change?
❖ What is going through your head?
❖ What will you prepare?

23. Case 7
❖ Jordan, 7 years old
❖ Fever and runny nose for 5 days, currently
on amoxycillin, referred by GP as now had
headache and stiff neck to assess for
meningitis
❖ What do you want to know?

24. Case 7
❖ Other concerning symptoms
❖ Truly rigid?
❖ Antibiotic effect?
❖ LP?

25. Case 8
❖ 7 week infant fever with rash
❖ Born at 34 weeks, NG feeds 1/52
❖ Crying
❖ Won’t feed

26. Case 8
❖ How aggressive with your investigations
and management?
❖ LP?