12801908
Descripción
Fichas por Averil Tam, actualizado hace más de 1 año
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Creado por Averil Tam
hace casi 7 años
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| Pregunta | Respuesta |
| 1. Identify which signs or symptoms indicate ‘toxicity’ in a child (alertness, breathing, cardiovascular, fluid intake/UO): a. 2 year old boy with 2 vomits this morning. HR 160, CRT 4s, T 36.9. | Cardiovascular difficulties |
| 1. Identify which signs or symptoms indicate ‘toxicity’ in a child (alertness, breathing, cardiovascular, fluid intake/UO): b. 1 year old girl, fevers to 40 at home for 2 days. Difficult to wake after her morning nap. | Decreased alertness |
| 1. Identify which signs or symptoms indicate ‘toxicity’ in a child (alertness, breathing, cardiovascular, fluid intake/UO): c. 6 month old boy, fever 38.1 one day after his 6 month immunisations. Alert, RR 65, no subcostal recession. | Breathing difficulties |
| 1. Identify which signs or symptoms indicate ‘toxicity’ in a child (alertness, breathing, cardiovascular, fluid intake/UO): d. 4 year old girl with 3 days of vomiting and diarrhoea. T 37.8, HR 120, CRT 3s, RR 20. She has not passed urine for 6 hours. | Decreased fluid intake and/or decreased urine output |
| 2. 5 week boy with one day of fever 38.5. Examination - mild runny nose only. Looks mildly unwell but is feeding as per usual. a. What is the most likely cause of fever in this age group? | Group B streptococcus. Although viral illnesses are the most common cause of fever in children, 12% febrile neonates have a serious bacterial infection. |
| 2. 5 week boy with one day of fever 38.5. Examination - mild runny nose only. Looks mildly unwell but is feeding as per usual. b. What are the risk factors for serious illness in this child? | Immature immune system, incomplete vaccination. |
| 2. 5 week boy with one day of fever 38.5. Examination - mild runny nose only. Looks mildly unwell but is feeding as per usual. c. What investigations should you do for this child? | Full septic work up including FBC and blood cultures, urine microscopy and culture (catheter specimen), LP for CSF microscopy, glucose, protein and culture and CXR. |
| 2. 5 week boy with one day of fever 38.5. Examination - mild runny nose only. Looks mildly unwell but is feeding as per usual. d. What treatment/follow up do you arrange for this child? | Admit to hospital for close observation, start empiric antibiotics while awaiting culture results. |
| TRUE/FALSE? 3. 3 year old boy with 48 hours of fever to 39. Previously well, UTD with immunisations. Normal vital signs, alert. No focus for fever on examination. a. The most likely cause of fever in this child is a serious bacterial infection. | False. The child is fully vaccinated and does not have any signs of toxicity so the risk or bacteraemia is <1%. The most likely cause of his fever is a viral illness. |
| TRUE/FALSE? 3. 3 year old boy with 48 hours of fever to 39. Previously well, UTD with immunisations. Vital signs are normal, alert. No focus for fever on examination. b. No further investigations are needed. | False. Consider urinalysis, microscopy and culture. The most common cause of bacterial infection in young children with fever and no clinical focus is UTI (up to 7% of febrile illnesses with no clinical focus in infants are due to UTI). |
| TRUE/FALSE? 3. 3 year old boy with 48 hours of fever to 39. Previously well, UTD with immunisations. Vital signs are normal, alert. No focus for fever on examination. c. You advise the parents that this is a viral illness and no further medical follow up is needed. | False. Follow up with local doctor 1-2 days to obtain urine culture results. Maintain hydration. If he develops ‘red flag signs” such as lethargy, persistent vomiting, significant tachypnoea or non-blanching rash they should seek earlier medical review. |
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