Febrile - definition
Single temp 38.5+ C or sustained temp > 38.0 C for >1 hr.
Causes
- UTI
- URTIs or pneumonia
- Meningococcal disease and bacterial meningitis
- Herpes simplex
- Kawasaki disease
Red flags
- High level of parental concern
- Re-presentation within 48hrs
- Clinical deterioration despite treatment
- Recent surgery or burns
High-risk patients
- Neonates
- Immunocompromised/neutropenic
- Invasive devices (e.g. CVC)
- ATSI
Sepsis - signs and symptoms
- Shivering/feeling cold, fever or hypothermia
- Extreme muscle pain or discomfort
- Pallor, discolouration or poor peripheral perfusion
- Sleepiness, slurred speech, lethargy, floppiness.
- Instinctive sense of being seriously unwell
- SOB, tachypnoea/dyspnoea
Other - oliguria, hypotension, hypoglycaemia, metabolic acidosis (elevated lactate).
Cold vs warm shock
Cold - narrow pulse pressure and prolonged CRT
Warm - wide pulse pressure, bounding pulses, flushed skin and rapid CRT.
Sepsis protocol
0-5min - early detection, involve senior clinician, cardio-respiratory monitoring, assess airway and breathing, O2T as req.
5-15min - venous access, blood samples (culture, VBG, lactate/glucose, FBE, CRP, UEC, LFT and coag), IV ABs.
15-30min: IV fluid resuscitation + additional boluses (max 40ml/kg) , monitor for fluid overload.
30-60min: inotropes/vasopressors if persistent circulatory failure (after max IV boluses), involve critical care.
* Consider urinalysis and LP once stable.
Neutropenia - protocol
Unstable or signs of sepsis - commence IV ABs, fluid resuscitation and blood sampling WITHIN 30MIN of arrival.
Stable - commence IV ABs (+/- fluid resuscitation) and blood sampling WITHIN 60MIN of arrival.
Neutropenia - definition
Neutrophil count < 500/mm(3)
Suspected - recurrent neutropenia OR oncology patient with oral/IV chemo in past 14 days.
Febrile seizures
Benign, common between 6months-6yrs.
Simple - generalised tonic-clonic, duration < 15 min, complete recovery within 60 min, nil recurrence.
Complex - focal features, duration > 15min, incomplete recovery, recurrence within same febrile illness.
Meningitis - definition
Inflammation of the meninges surrounding the brain and spinal cord due to bacterial (MEDICAL EMERGENCY) or viral infection.
Encephalitis - definition
Inflammation of the brain parenchyma.
Meningitis - signs and symptoms
- Fever
- Purpuric rash (non-blanching)
- Seizures
- ALOC - irritability, drowsiness.
- Nausea, vomiting or diarrhoea (or poor feeding in infants)
- Pain - headache, neck stiffness, photophobia.
Meningitis - treatment
- Investigations - blood samples (panels & cultures), LP and imaging (encephalitis, focal symptoms or signs of RICP)
- Isolation - droplet precautions for first 24hrs.
- ABs - administered WITHIN 30MIN of decision to treat.
- Seizure protocol
- Fluid restriction
