Diagnostic clues to evaluating the febrile child

URTI
1. very common
2. may be coincidental w/ another serious illness
otitis media
1. always examine tympanic mb in febrile kids
tonsillitis
1. erythema/exudate on tonsils?
stridor
1. epiglottitis?
2. viral croup?
3. bacterial tracheitis
pneumonia
1. fever
2. cough
3. raised resp rate
4. chest recession
5. abnormal auscultation
  1. in infants auscultation may be normal
    1. diag may need CXR
septicaemia
1. hard to recog if no rash before shock develops
2. early signs
  1. raised HR
  2. raised breathing rate
  3. poor perfusion
3. need to start Abx on clinical suspicion
  1. don't wait for results
meningitis/encephalitis
1. lethargy
2. loss of interest in surroundings
3. drowsiness or coma
4. seizures
5. older kids
  1. headache
  2. photophobia
  3. neck stiffness
  4. +ve Kernig sign
    1. pain on leg straightening
6. younger kids & infants
  1. non-specific sx & signs
7. raised ICP
  1. reduced conscious level
  2. abnormal pupillary responses
  3. abnormal posturing
8. Cushing triad
  1. bradycardia
  2. hypertension
  3. abnormal pattern of breathing
9. late signs
  1. papilloedema
  2. bulging fontanelle in infants
  3. opisthotonus
    1. hyperextension of head & back
seizure
1. febrile convulsion?
2. meningitis?
3. encephalitis?
periorbital cellulitis
1. redness & swelling of eyelids
2. may spread to orbit
rash
1. viral exanthem?
2. purpura from meningococcal infection
UTI
1. urine sample needed for any seriously ill young child or febrile illness that doesn't settle
abdominal pain
1. appendicitis?
2. pyelonephritis?
3. hepatitis?
diarrhoea
1. gastroenteritis
2. fever w/ blood & mucus in stool
  1. Shigella
  2. Salmonella
  3. Campylobacter
osteomyelitis or septic arthritis
1. suspect if painful bone or joint
  1. or reluctance to move limb
prolonged fever
1. bacterial infection
  1. UTI
  2. bacterial endocarditis
2. other infections
  1. viral
  2. fungi
  3. protozoal
3. Kawasaki disease
4. drug rxn
5. malignant disease
6. connective tissue disorder

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Diagnostic clues to evaluating the febrile child

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	Creado por v.djabatey hace más de 10 años