childhood fever
TRANSCRIPT
1
Childhood FeverChildhood Fever
Capt. Rick RobbinsLouisville Metro EMS
2
Introduction Introduction
What's is consider a fever How do we assess a child with a fever Causes Management
3
FEVERFEVER
Defined as a rectal temp 100.5 or higher. It usually arises due to a mild infection of
the upper respiratory or gastrointestinal tract.
4
FEVERFEVER
Studies have shown that fever helps the immune system fight infections.
Most children are not particularly uncomfortable with fever, particularly if it is lower than 39.5ºC (103ºF).
5
FEVERFEVER
Sometimes fever is caused by a serious medical condition, such as:
Meningitis Pneumonia Bacterial infection of the blood. These are true medical emergencies. The
initial assessment and focused history findings will usually indicate that the child’s condition is urgent
6
FEVERFEVER
Fevers in a young infant is considered more urgent than fever in an older child. Any infant aged three months or younger who has a rectal temperature of 100.5 degrees Fahrenheit or higher should have be evaluated
7
FEVERFEVER
Any child with fever who has decreased ability to fight infection should be considered potentially unstable. Transport the child for further medical evaluation, even if all assessment findings are normal.
8
FEVERFEVER
If fever is accompanied by: altered mental status respiratory distress signs of shock seizures bruise-like or spotty rash on the trunk or
extremities a stiff neck consider the child’s condition urgent.
9
FEVERFEVER
LOC Awake Irritable Inconsolable by parents unconscious
10
FEVERFEVER
Look, listen, and feel for air movement. IS the airway is patent without positioning or
suctioning. Allow the child to remain in a position of
comfort. Position the airway as necessary. Suction secretions as needed, giving high- concentration oxygen before and after
suctioning. A child with decreased responsiveness who is
unable to maintain the airway should receive assisted ventilation using a bag-mask device.
11
FEVERFEVER
The normal breathing rate for the child’s age increases by approximately four to five breaths per minute for each degree Fahrenheit of fever.
The normal pulse rate for the child’s age increases by approximately ten to twelve beats per minute for each degree Fahrenheit of fever.
12
FEVERFEVER
Mild tachypnea is a common finding with fever. By itself not necessarily a problem.
Tachypnea, increased work of breathing, abnormal central skin color, or other abnormal respiratory findings, assume the child’s condition may be urgent.
13
FEVERFEVER
Check skin color and temperature as well as capillary refill time.
Measure blood pressure in children older than 3 years.
Mild tachycardia is a common finding in children with fever.
Signs of hypovolemic or septic shock are urgent findings. Compensated septic shock is indicated by warm, pink skin with normal or delayed capillary refill and bounding pulses.
14
FEVERFEVER
Test blood glucose levels in children with altered mental status and treat for hypoglycemia as indicated
15
HISTORYHISTORY
Age—infants aged 2 months or younger have decreased ability to fight infection and should be transported if the temperature is 38ºC (100.5ºF) or higher
Headaches and emesis— the combination of fever, headaches, and emesis suggests meningitis, particularly if altered mental status is present as well.
16
HISTORYHISTORY
Seizures—while febrile seizures are usually brief and do not harm the child, they may be a sign of meningitis
Poisoning—ingestions involving aspirin, certain antidepressants, and other drugs can cause fever; contact medical control or a poison control center for further instructions
17
HISTORYHISTORY
Heart disease or pulmonary problems—children who have a history of heart disease or pulmonary problems may be unable to tolerate tachycardia and tachypnea associated with fever
18
HISTORYHISTORY
Immunocompromise—children with sickle-cell anemia, HIV, nephrotic syndrome, a history of recent chemotherapy, autoimmune disorders , or a history of splenectomy have
decreased ability to fight infection
19
HISTORYHISTORY
The following findings also increase the child’s risk for serious complications of fever.
Compromised immune function due to high-dose steroids, such as prednisone,
taken for 2 weeks or longer anti-rejection medications following an
organ transplant
20
HISTORYHISTORY
Increased risk of local bacterial infection due to
hydrocephalus with a shunt congenital heart disease placement of a central intravenous catheter home peritoneal dialysis
21
ASSESSMENTASSESSMENT
Signs to look for during the detailed physical examination include
nuchal rigidity in a child or a distended fontanel in an infant, potential signs of meningitis
focal neurologic findings, such as unequal pupils or decreased unilateral movement, possibly indicating meningitis or a ventricular peritoneal shunt infection
22
ASSESSMENTASSESSMENT
sunken eyes, lack of tears, dry mucous membranes, decreased skin turgor, and other signs of dehydration
petechiae, purpuric lesions, or any rapidly spreading skin rash
abdominal scar located in the left upper quadrant suggestion a splenectomy
23
MANAGEMENTMANAGEMENT
Any infant aged 2 months or younger who has a rectal temperature of 38ºC (100.5ºF) or higher should be evaluated by a physician, as there may be a serious bacterial infection requiring antibiotic treatment.
Children aged between 2 months and 3 years who have a rectal temperature exceeding 39.5ºC (103ºF) should also be considered urgent, as they may have occult infections in the blood or urine.
24
MANAGEMENTMANAGEMENT
Administer anti-pyretic agent if directed. Cool with moisten lukewarm towels. DONOT !!! use cold packs or ice. May
cause shivering increasing temperature.
25
COMPLICATIONSCOMPLICATIONS
Febrile Seizures Rashes Septic Shock
26
FEBRILE SEIZUREFEBRILE SEIZURE
Febrile seizures are a potential complication of fever.
This type of seizure occurs most often in children aged 6 months to 6 years. About 5% of all children experience a febrile seizure before they are 6 years old.
27
FEBRILE SEIZUREFEBRILE SEIZURE
Many febrile seizures are of short duration, lasting less than 1 to 2 minutes. The majority last from 10 to 15 minutes.
28
FEBRILE SEIZUREFEBRILE SEIZURE
Simple febrile seizures involve tonic-clonic movements affecting the entire body.
All simple febrile seizures last less than 15 minutes, and most last only a minute or two.
They occur no more than once within a 24-hour period.
About one-third of children with simple febrile seizures will experience a recurrence, although usually not during the same illness.
29
FEBRILE SEIZUREFEBRILE SEIZURE
Complex febrile seizures begin with localized bodily movements. They can last longer than 15 minutes and may occur more than once within a 24-hour period.
In a few cases, febrile seizures may last longer than 30 minutes, in which case they are categorized as febrile status epilepticus.
30
FEBRILE SEIZUREFEBRILE SEIZURE
All reported seizures need to be transported.
Was it febrile, or new onset of problems other than fever?
31
RASHESRASHES
Many pediatric infections are accompanied by rashes.
Familiarizing yourself with the characteristics of these rashes can help you evaluate the seriousness of the child’s condition.
Accurately documenting rashes provides important information for hospital emergency department receiving personnel as rashes can progress.
32
RASHESRASHES
Purpuric versus viral rashes Purpuric rashes consist of reddish-purple
skin lesions that do not blanch on application of slight finger pressure.
Purpuric lesions can be either petechiae or ecchymoses.
Petechiae are small, flat lesions less than 2 mm in diameter.
33
RASHESRASHES
Ecchymoses are larger; they may be raised above skin level and are sometimes tender to the touch.
Purpuric lesions may denote loss of platelets or clotting factors due to disseminated infection or sepsis.
Purpuric rashes are more frequently bacterial than viral in origin.
34
RASHESRASHES
Viral rashes tend to be made up of erythematous lesions, which can be macular or papular.
These rashes usually blanch with slight finger pressure.
They tend to be diffusely located on the body. Most start at the face or torso, spreading
inferiorly toward the toes and laterally toward the extremities.
36
purpuric lesionspurpuric lesions
37
SEPTIC SHOCKSEPTIC SHOCK
Septic shock Septic shock is a type of distributive shock
associated with bacterial infection in the blood. In compensated septic shock, there is marked vasodilation, which causes blood pressure to drop as the blood supply fills a greater space.
38
SEPTIC SHOCKSEPTIC SHOCK
Compensated Septic Shock
Tachycardia Normal capillary
refill time Warm, pink skin Bounding peripheral
pulses Widened pulse
pressure
Other Compensated Shock
Tachycardia Slow capillary refill
time Cool, pale skin Weak peripheral
pulses Narrow pulse
pressure
Tachycardia
39
Temperature MeasurementTemperature Measurement
Rectal temperature is considered the standard, as the rectum is insulated from environmental temperatures and has an excellent arterial blood supply
A parent’s tactile assessment of the child’s forehead identifies the presence of fever about50% to 75% of the time. The accuracy of axillary temperature readings is similar.
Heat-sensing strips placed on the forehead identify fever about 10% to 25% of the time.
40
Temperature MeasurementTemperature Measurement
The accuracy of oral temperature measurement is adversely affected if the thermometer is not positioned correctly under the tongue.
Tympanic thermometers are rising in popularity, as they are less invasive than rectal measurement and have good reported accuracy.
41
Temperature MeasurementTemperature Measurement
Temporal artery thermometers, a recent development in noninvasive temperature measurement, involve a probe that is placed over the forehead and moved laterally along the skin surface over the temporal artery just anterior to the ear. This device has reasonable accuracy. Children may find it more comfortable than a tympanic thermometer.
42
SUMMARYSUMMARY
Since it is not always possible to distinguish a mild infection from a life-threatening condition, any child with fever should be transported for further evaluation unless medical control directs otherwise. In children with fever, the presence of additional risk factors for infection, such as sickle-cell anemia or HIV, is cause for prompt transport and evaluation in the emergency department, even if all assessment findings are normal.
43
The EndThe End
ANY QUESTIONS?
44
Where to Get More InformationWhere to Get More Information
Other training sessions List books, articles, electronic sources Consulting services, other sources