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Define fever of unknown origin (FUO)
- -documented fever >2-3weeks with outpatient visits and studies
- -No etiology after 1 week of eval in hospital
How is heat produced in the body?
- -With illness, pathogens release endogenous pyrogens that reset the hypothalamic center
- -increased cellular metabolism, involuntary shaking, thermo response, auto response like vasoconstriction, exercise, behavioral responses
When is the body temperature the lowest/highest?
- lowest--> 2-6AM
- highest--> 5-6pm
-mild increase of 1-1.5 degrees F can be caused by exercise, excess clothing, hot bath, weather, hot car
When is an oral temp appropriate in kids?
Every increase in degree of temp causes what increase in HR and RR?
- -HR 10-15 beats/min
- -RR 3-5 breaths/min
What are the 2 most common bacterial cause of fever in <2mo?
What bacteria are most common sources of fever in >2mo? KNOW
- 1. S. pneumoniae
- 2. GBS
- 3. N. meningitidis
- 4. H. Flu
List 5 acceptable sources of fever.
- 1. Croup (known viral w/ high fever, barky cough)
- 2. Roseola (viral <18mo, low temp & papular rash)
- 3. Stomatitis (certain seasons- coxsackie pharyngitis)
- 4. Otitis media (although not all have fever)
What should you consider with "prolonged" fever?
- -Unusual infectious disease (kawasaki)
- -Collagen vascular disease
- -munchausen dx
What determines a toxic appearing child?
- -rash (petechia over several surfaces)
- -Increased RR
What are the 6 parts of the Acute Illness Observation Scale?
- 1. Quality of cry
- 2. Responsiveness to cuddling
- 3. Alertness
- 4. Interactive for age
- 5. Color
- 6. Hydration
What is the most common serious bacterial infection seen in febrile infants?
T or F. All febrile (T-100.4) children <28 days should be admitted to the hospital.
T or F. Infants 4-8 weeks with bronchiolitis/influenza who are well-appearing should undergo limited lab eval.
True: if CBC/UA are benign and culture pending
What are the parts of a full sepsis workup? (4)
- 1. CBC, blood cx
- 2. UA, urine cx
- 3. CSF cx
- 4. Empiric antibiotic therapy
T or F. Most febrile infants 4-8 weeks "who present to the ER" warranta full eval for SBI.
T because cannot ensure adequate f/u and threshold for LP should be low
What are the criteria for observing a child 8-12weeks with no treatment? (5)
- 1. WBC 5-15,000
- 2. Bands <20%
- 3. ANC >1000
- 4. U/A <5 WBC
- 5. Stool <5 WBC (if diarrhea present)
What is the ceftriaxone dose for kids 8-12weeks with sepsis?
- --> meningitic dose is 100mg/kg
What should you consider in a kid 8-12 weeks with a fever, source?
- -bone or joint
T or F. No lab test or antibx if fever w/out a source is < 102.2 in infants 3-36ml
True, prescribe antipyretics and return if fever persists >48hrs
In kids 3-36mo with T>102.2 (39C), what should you consider?
- -occult bacteremia
- -occult UTI
- -occult pneumonia
T or F. All childen <1 year should be evaluated for occult UTI if T >102.2 between 3 to 36mo?
- FALSE--> all children < 6mo
- -Uncircumcised boys < 1yo
- -Girls <24 mo if 1 or more risk factors (fever >2days, <12mo, white, no alternative source)
What is Brudzinski's sign?
-Supine--> head is lifted toward sternum and (+) if patients resist head lift or flex hips/kneeds
What is Kernig's sign?
-(+) if pain and reflex contraction in hamstring muscles when attempting to extend leg after flexin the thigh upon the body
When should a child with fever be seen immediately?
- -Child <3mo
- -crying inconsolably
- -cries when moved or touched
- -difficult to awaken
- -stiff neck
- -petechia on skin
- -difficulty breathing
- -drooling and unable to swallow
- -seizure has occured
- -child acts or looks sick
What is the tylenol and motrin dose for fever?
Tylenol--> 10-15mg/kg dose q 4-6hr if >102 or pain
Motrin--> 5-10mg/kg dose q 6-8hr
**can also add sponging w/ luke warm water & increase fluid intake