The Pyrexial Child
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The document discusses the assessment and management of febrile children in primary care. It outlines appropriate methods for measuring temperature in children of different ages. Common causes of fever are infections, but also include conditions, convulsions, and external factors. Children are assessed using a "traffic light" system to determine the level of risk (green, amber, red) based on symptoms and history. Management involves antipyretics, hydration, and follow-up care or referral depending on risk level. Specific infections that may cause fever are also mentioned.
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Ffion Davies gives her take on how to spot the sick child in the Emergency Department.
Paediatric medicine is no doubt hard and can at times be scary. There is nothing worse, in Ffion’s opinion, than sending a child home who later represents to the hospital in a worse condition, or even worse, later dies.
So, how does one spot the sick child amongst the droves of children who will present with fever and vomiting.
In this talk, Ffion gives a lesson on how to spot the sick children in the ‘grey’ zone – those that are not clearly sick and not clearly well.
Ffion breaks her thinking into two main areas: physiology and psychology.
Physiology matters. Scrutinising a full set of observations/vitals (in the context of the child’s age) will help avoid the feared crime of discharging a sick child.
Ffion discusses tachypnoea as a prime example of a simple physiological compensation to raise one’s suspicion of serious disease.
Similarly, psychology matters. Ffion talks in depth as to why she considers this to be true.
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Less knowledge, less experience and perhaps less confidence. Compounding this is the complexities of having to deal with the stressed parents when you yourself are stressed because of the situation.
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Paediatric medicine is no doubt hard and can at times be scary. There is nothing worse, in Ffion’s opinion, than sending a child home who later represents to the hospital in a worse condition, or even worse, later dies.
So, how does one spot the sick child amongst the droves of children who will present with fever and vomiting.
In this talk, Ffion gives a lesson on how to spot the sick children in the ‘grey’ zone – those that are not clearly sick and not clearly well.
Ffion breaks her thinking into two main areas: physiology and psychology.
Physiology matters. Scrutinising a full set of observations/vitals (in the context of the child’s age) will help avoid the feared crime of discharging a sick child.
Ffion discusses tachypnoea as a prime example of a simple physiological compensation to raise one’s suspicion of serious disease.
Similarly, psychology matters. Ffion talks in depth as to why she considers this to be true.
Talks on Paediatric Emergency Medicine are always popular because Emergency Medicine physicians are insecure about mismanaging a child. Are children precious? Are adults just big children? Therein lies the problem.
Less knowledge, less experience and perhaps less confidence. Compounding this is the complexities of having to deal with the stressed parents when you yourself are stressed because of the situation.
Ffion continues to talk about systems of thinking and decision making. She compares Type 1 thinking which is automatic and instinctive with Type 2 thinking, which is more considered. She explains the risks and benefits of relying more upon Type 2 thinking when considering the sick child in the Emergency Department.
Finally, Ffion concludes by talking about strategies to improve your own management of the paediatric population in the Emergency Department. She discusses improving your knowledge base, using resuscitation aids and checklists and training by using stress inoculation simulations.
For more like this, head to our podcast page. #CodaPodcast
Respiratory lecture nurs 3340 spring 2017
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please comment
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For Q1, it states that asthma is difficult to diagnose before 5 years due to limitations of diagnostic tools like spirometry. However, recurrent stridor, cough, atopy and family history of asthma suggest a predisposition. For severely symptomatic children, response to 2-3 months of inhaled corticosteroids can help confirm the diagnosis.
For Q2, red flags include symptoms not improving after 48 hours of oral steroids, and rapidly worsening symptoms with breathing difficulty and altered consciousness.
For Q3, parents can reduce exposure to known allergens and triggers, and control factors like secondhand smoke,
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Paediatric history
Paediatric history and examination
Paediatric history
Summary
Standard history, plus the paediatric extras, BINDS:
Birth
Immunisations
Nutritrion/feeding
Development
Social history in detail, including School, Siblings, Smoking (parents), Salaries (parents' jobs), and Social services input.
Past medical history
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Ask specifically about asthma.
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- 13. Herpes Simplex Encephalitis Meningitis, Meningococcal Dis Pneumonia Kawasaki disease UTI Septic arthritis/osteomyelitis • Neck stiffness • Bulging fontanelle • level of consciousness Non-blanching with 1 or more: • an ill-looking child • larger than 2 mm in diameter • CRT ≥3 seconds • neck stiffness Fever >5 days & 4 of the following: • bilateral conjunctival inj • change in URT mucous membranes ( eg, injected pharynx, dry cracked lips or strawberry tongue ) • change in the periph extremities ( eg,oedema, erythema or desquamation ) • polymorphous rash • cervical lymphadenopathy • Focal neur signs/ fits • level of consciousness • Tachypnoea 0–5 m – RR > 60 b/m 6–12 m – RR > 50 b/m > 12 m – RR > 40 b/m • Crackles, Nasal flaring, Chest indrawing, Cyanosis • Sats ≤95% (> 3 months) • Poor feeding, Vomiting, Lethargy, Irritability, Abdo pain • Frequency or dysuria • Offensive urine or haematuria • Swelling of a limb or joint • Not using an extremity • Non-weight bearing + FEVER
Editor's Notes
- Children with feverish illness should be assessed for the presence or absence of symptoms and signs that can be used to predict the risk of serious illness using the traffic light system
- 5% skin - decreased turgor dry m membranes fontanelle - may be slighly depressed eyes - slightly sunken pulses - normal resp pattern- may be abnorm mental state - may be normal 10% skin - decreased turgor with poor CR dry m membranes fontanelle - depressed eyes - sunken pulses - poor vol resp pattern - abnormal mental state - lethargic oliguria may be noted > shock - falling BP with tachycardia coma anuria
- 5% skin - decreased turgor dry m membranes fontanelle - may be slighly depressed eyes - slightly sunken pulses - normal resp pattern- may be abnorm mental state - may be normal 10% skin - decreased turgor with poor CR dry m membranes fontanelle - depressed eyes - sunken pulses - poor vol resp pattern - abnormal mental state - lethargic oliguria may be noted > shock - falling BP with tachycardia coma anuria
- Symptoms and signs of specific diseases
- Care at home ● Advise parents and carers: – of the antipyretic interventions available – to offer their child regular fluids (if breastfeeding then continue as normal) – to look for signs of dehydration: ◆ sunken fontanelle ◆ dry mouth ◆ sunken eyes ◆ absence of tears ◆ poor overall appearance – to encourage their child to drink more fluids and consider seeking further advice if they see signs of dehydration – how to identify a non-blanching rash – to check their child during the night – to keep their child away from nursery/school while the fever persists and to notify the nursery/school of the illness. ● Advise parents and carers to seek further advice if: – the child has a fit – the child develops a non-blanching rash – they feel that the child’s health is getting worse – they are more worried than when they last received advice – the fever lasts longer then 5 days – they are distressed or concerned that they are unable to look after their child.
- ● Provide the parent or carer with verbal and/or written information on warning symptoms and how further healthcare can be accessed. ● Arrange a follow-up appointment at a certain time and place. ● Liaise with other healthcare professionals, including out-of-hours providers, to ensure the parent/carer has direct access to a further assessment for their child.