Fever >4 months
Prereading :
| CHQ Fever Guideline |
Workbook Questions
Case 1
A well looking toddler presents to ED with intermittent fevers for last 24 hours. He is well in between fevers and mum has been using Panadol to control his temperature. His observations are all within normal limits including a HR of 126 and CRT < 2 secs and on examination he is coryzal with a slightly red pharynx. His temperature is 38.1. You decide he has a viral URTI and want to send him home but mum has some questions for you.
A 19-month-old boy presents with a high fever and looks quite miserable. Mum says he has been unwell for 2 days, beginning with a runny nose and a vomit yesterday. His Temp is 39.6, HR is 160, CRT 2 secs, RR 28 and Sats 100%. On exam, he is coryzal and has a red pharynx and tympanic membranes.
Case 3
A 9-month-old, immunised girl presents with a high fever. Mum states today is day 3 of illness and every day she has had a fever over 38 degrees. She appears miserable when she is febrile and often vomits at the same time. At present, she looks quite well and is playing in the bed. Her Temp is 37.9, HR 160, CRT < 2 secs, RR 28. On examination, you cannot find a source for her fever.
Case 4
A 3-year-old child presents with a high fever, whilst examining her she is well but you notice a few petechial spots on her face and chest.
Case 1
A well looking toddler presents to ED with intermittent fevers for last 24 hours. He is well in between fevers and mum has been using Panadol to control his temperature. His observations are all within normal limits including a HR of 126 and CRT < 2 secs and on examination he is coryzal with a slightly red pharynx. His temperature is 38.1. You decide he has a viral URTI and want to send him home but mum has some questions for you.
- What is the best way to measure a temperature at home and how high does it have to be to be classed as a fever?
- How high is the fever allowed to go, should I be worried if it is over 40?
- Should I keep giving him Panadol and Nurofen whilst he has a fever and how long can I keep giving it for?
- How long do the fevers normally last?
- When should I come back, how do I know I he’s getting worse?
A 19-month-old boy presents with a high fever and looks quite miserable. Mum says he has been unwell for 2 days, beginning with a runny nose and a vomit yesterday. His Temp is 39.6, HR is 160, CRT 2 secs, RR 28 and Sats 100%. On exam, he is coryzal and has a red pharynx and tympanic membranes.
- You think he has a viral URTI. Can he go home straight away and why?
- You decide to keep him for some observation, what treatment would you initiate?
- Will you do any investigations at this point?
- How will you decide when he is ready to go home?
Case 3
A 9-month-old, immunised girl presents with a high fever. Mum states today is day 3 of illness and every day she has had a fever over 38 degrees. She appears miserable when she is febrile and often vomits at the same time. At present, she looks quite well and is playing in the bed. Her Temp is 37.9, HR 160, CRT < 2 secs, RR 28. On examination, you cannot find a source for her fever.
- What would you do at this point? Can she go home or does she need more observation? Are you worried about anything?
- Would you do any investigations at this point?
- Whilst observing her she begins to look more miserable, her temperature is 38.9, HR 172, CRT 3 seconds and looks a little mottled.
- How would you change your management at this point, would you initiate any treatment?
- She appears quite lethargic, do you need to do an LP, how would you decide this?
Case 4
A 3-year-old child presents with a high fever, whilst examining her she is well but you notice a few petechial spots on her face and chest.
- How would you manage this case? Would you do any investigations? Give antibiotics? And what is her likely disposition?