MODULE 1 - CMN 568 WITH 100% CORRECT ANSWERS

Fever causes by age in infants? Causes: Less than 1month: Group B Strep, E. Coli 1 mo-3 mo: strep pneumoniae, H. Influenzae, N. Meningitidis Fever without source of infection: most common cause – H.Influenza Type B & Strep Pneumoniae Fever appearance in infants for non toxic vs toxic? Non-toxic appearance: consolable Toxic appearance: weak, high pitched cry, inconsolable Seen Immediately: neck stiff, fever 40.6 C, 3mo + fever 38C, petechiae, drooling saliva and unable to swallow anything, child has sickle cell disease/ splenectomy/ HIV/ chemotherapy/ organ transplant/ chronic steroids Tympanic route is not accurate in infants 3mo. RED FLAGS FOR SERIOUS ILLNESS: 1mo: 40C temp, petechial rash, meningeal irritation, resp signs (tachypnea, stridor, increased WOB, crackles, decreased breath sounds, cyanosis), hypotension. In neonates, meningeal irritation can present as labile temperature. Any infant less than 1 month old with fever should be hospitalized and have full sepsis work up Define fever temperature in infants Rectal temp: 38 C (100.4 F). Determine based on presentation (non-toxic/toxic). Acetaminophen dosing in children? Acetaminophen (Tylenol) – 10-15mg/kg q4-6hrs. MAX: 5 doses/24 hours Ibuprofen dosing in children? Ibuprofen (Motrin/Advil) – 5-10mg/kg q6-8hrs. MAX: 40mg/kg/day TOTAL 6mo or older Fever treatment for.... Infants less than 4 weeks? Infants 4 weeks to 3 months? Infants 3 months to preschool? Infants less than 4 weeks: risk of sepsis!! Full septic work-up – blood culture, CXR if indicated, stool culture. AVOID CEFTRIAXONE (Rocephin). Refer to ED. Ampicillin, cefotaxime, acyclovir. Infants 4 weeks - 3 months: Toxic appearance (risks for SBI [systemic bacterial infection]): full septic work up. CXR if indicated, stool cultures. Refer to ED. Empiric IV abx pending culture. Non-toxic appearance (no risk for SBI): full septic work-up. CXR. Outpatient if pt has reliable caregiver. Rocephin 50mg/kg/day (empiric abx). Infants 3 months - preschool: Toxic appearance: septic workup. Lumbar puncture, CXR, stool culture, rapid viral testing. Empiric abx (pending culture results) Non-toxic appearance: lab work-up guided by H&P. Empiric abx (pending culture results) Moderate – severe bulging of TM. MUST have bulging TM and MEE (middle ear effusion) Severe DX: toxic appearance, pain 48hrs, temp 102.2