Physical exam signs of serious infection: Musculoskeletal - Answer: Refusal to bear weight or
use an extremity, erythema/warmth over joint
Diagnostic tests for fever in infant and young child - Answer: CBC w/ Diff (WBC > 15,000 may
indicate SBI. Child with overwhelming sepsis my have WBC <5,000)
UA/ C&S: R/O UTI
CXR: R/O Pneumonia
Lumbar Puncture: R/O meningitis
Blood cultures: R/O Bacteremia
Stools for C&S: R/O Infectious diarrhea
Management of fever in infant < 4 weeks - Answer: Refer to pediatrician
Hospitalization
Full septic workup
IV antibiotics pending culture results
Management of fever in infant 4 weeks - 3Mo - Answer: Toxic appearance:
Refer to pediatrician
Hospitalization
Full septic workup
IV antibiotics pending culture results
Non-Toxic appearance/No risk factors for SBI:
Full septic workup
Page 2 of 80
,Specific treatment for any diagnosed conditions
Empiric antibiotics after cultures: Rocephin 50mg/kg/day (up to 1 gm max)
Must have reliable caregiver with phone and transportation
Close followup in 24 hours
Management of fever in 3Mo to Preschool - Answer: Toxic appearance:
Septic work up
Consider hospitalization and IV antibiotics, especially if no focal source of fever can be identified
Non-Toxic appearance:
Lab work up guided by H&P
CBC with Diff
CXR if cough or dyspnea
Stool C&S if diarrhea
UA: all girls under 2yo, all males under 6Mo, uncircumcised males under 12Mo
Non-Toxic appearance:
Fever <39 (102) no obvious source: Antipyretics, close followup by visit or phone
Fever >39 (102) antipyretics, consider empiric antibiotics, close followup by visit or phone
Incidence of Fever - Answer: One of most common reasons for parents to seek medical care.
Preschoolers have an average 6-8 febrile illnesses a year.
Definition of fever - Answer: Rectal temperature ≥ 100.4°F
Tympanic temperature - Answer: Not accurate in infants under 3 months
Fever Causes - Answer: Most common Benign viral illness, can also caused by bacterial or fungal
infections, drug reactions including immunizations, malignancies, autoimmune or metabolic
disorders, CNS disorders, excessive environmental temperatures.
Page 3 of 80
, Factors that increase likelihood of serious bacterial illness - Answer: Age under 3 months,
history of prematurity, chronic medical conditions such as immunosupression or aspenia,
previous hospitalizations, daycare. Toxic appearance
Non-Toxic appearance - Answer: Strong cry
Consolable
Alert and easy to arouse
Pink skin tones
Good hydration; good turgor, tears, moist mucous membranes
Smiles, responsive to environment
Toxic appearance - Answer: Weak or high pitched cry
Inconsolable
Difficult to arouse
Pale, ashen, cyanotic, or mottled skin tones
Poor hydration; poor turgor, dry mucous membranes, no tears
No smile, listless, dull, infant won't alert to environment
Antipyretic - Answer: Acetaminophen: 10-15mg/kg Q 4-6 Hrs (Max 5 doses in 24 hours)
Ibuprofen: 5-10mg/kg Q 6-8hrs (max 40mg/kg/day)
Never use aspirin
Educate parents on risk of overdosing and review concentration information.
Fever-Home Care - Answer: Increased fluids to maintain hydration
Light clothing/blankets to help reduce fever
Tepid sponge baths if fever unresponsive to antipyretics
No alcohol or cold water baths
Page 4 of 80
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