Fever Examination - Patient Management

Fever

·        Taking a temperature:

o  Serial measurements the most useful

o  Also take pulse – if ­temp should have ­heart rate (except in typhoid)

    Normal Values : Low    High

§  Oral          36.6   37.2

§  In hot weather  +0.5   +0.5

§  Rectal       +0.2   +0.5

§  Axillary    -0.5    -0.5

·        Children. The most common emergency presentation in paediatrics. Most common cause is viral infection, otitis media, pharyngitis, and tonsillitis. Also consider bladder infection, Rheumatic fever, Meningitis. Kids spike temperature easily. Febrile convulsions occur between 18 months and 5 years. At other ages investigate other causes

·        Types of fever:

o   Continued: does not remit e.g. typhoid, drug fever

o   Intermittent: falls to normal each day – pyogenic infections, lymphomas

o   Relapsing: returns to normal for days then rises again – Malaria, lymphoma, pyogenic

Fever in Children

·        Most fevers caused by respiratory tract viral infection, are self-limiting, and require only symptomatic treatment.

·        Kids have 6 – 8 viral infections each year ® they are common

·        Role of doctor:

o   Identify source of infection

o   Counsel caregivers and child

o   Manage the illness

o   Identify and refer those with potentially serious illness

·        If no focus found:

o   Consider UTI, occult pneumococcal bacteraemia, meningitis 

o   Consider non-infectious causes: rheumatic fever, poisoning, drug fever, more rarely leukaemia and other autoimmune diseases (eg Kawasaki‟s Disease)

o   On exam, pay attention to:

§  General appearance: activity, perfusion, colour

§  Vital signs: pulse, respiration, blood pressure 

§  Exclude: fontanelle, neck stiffness, respiratory distress, abnormal chest signs, ears, throat, lymphadenopathy, hepatosplenomegaly, abdominal distension, bone or joint tenderness/swelling, skin rashes

o   At greater risk: neonates, immunocompromised, congenital abnormalities, toxic appearance, epidemiological ­ risk (eg Maori)

o   WBC are unreliable for detection serious infection

o   Review within 24 hours and parent education

·        Advice for parents:

o   Light clothing

o   Small, frequent drinks of water or fruit juice diluted 1:4, 5 – 7 mls/kg/hr

o   Paracetamol, 15 mg/kg/6 hourly, max of 90 mg/kg/day for 2 days 

o   Return to doctor if refusing drink, pale or floppy, difficulty breathing, headache/neck stiffness/photophobia, doesn‟t improve in 48 hours

·        Clues for predicting serious illness (even over the phone):

o   Responsiveness and activity

o   Feeding

o   Urine output

o   Breathing

o   Colour