kids with bugs
TRANSCRIPT
EMET
Kids with Bugs Dr Ian Turner
Temperature
❖ >38C (rectal in under 3 months)
❖ Consider hypothermia
❖ Temp higher in evening
Where’s the fever from?
Bacteria
Streptococcal pharyngitisOtitis mediaPneumoniaUTICellulitisMeningitisSeptic arthritisOsteomyelitis
Where’s the fever from?
Viruses
RTIsPharyngitisGastroenteritisOtitis mediaMeningitis/encpehalitis
Where’s the fever from?
Non-infective
MalignancyAuto-immuneImmunisationsDrugsEnvironmentThermometer
Age matters
❖ <1 month (neonate)
❖ 1-3 months (infant)
❖ <3 months - 17% UTI, 2% bacteraemia, 0.9% meningitis
❖ >3 month
❖ investigations and treatment affected
Neonate❖ Bugs from mum
❖ GBS, E coli, Listeria, Haemophilus, HSV
❖ UTI, meningitis
❖ PROM, prematurity, multiple pregnancy, vaccinations
❖ Do the LP
❖ Refer to appropriate guidelines (eg. penicillin and gentamicin OR cefotaxime)
❖ Consider acyclovir
Infant
❖ Strep, Neisseria, Staph, Haemophilus, Salmonella, Shigella, HSV
❖ Do the LP if you suspect
❖ Refer to appropriate guidelines (eg. ceftriaxone, penicillin)
❖ Consider acyclovir
❖ Low risk - previously well, looks well, normal vitals, WCC 5-15, clear urine
3 month to toddler
❖ Safer age group
❖ MSU minimum
❖ Clear site
❖ Well or unwell?
❖ Refer to appropriate guidelines (ceftriaxone, flucloxacillin)
Case 1
❖ Cooper, 7 months old, usually well
❖ 3 days of fever
❖ Seen by GP
Case 1
❖ 38.1C, RR 32, SaO2 99%, HR 160
❖ Alert, smiling, playing
❖ Nil focus found
Case 1
❖ Returns following day
❖ Fevers resolved
❖ But mum very worried about new rash
Case 2
❖ Isabella, 4 years old
❖ ALL age 13 months
❖ Coughing for 3 days
❖ Now has fever and rash
Case 2
❖ Supportive care
❖ Seek and treat complications
❖ Contacts
Case 3
❖ Patrick, 5 years old
❖ Fever and limp for 3 days
❖ Now cannot walk
❖ Carried into department by dad
Case 3
❖ No trauma or recent URTI
❖ No hip problems when younger
❖ Looks unwell
❖ 38.9C, HR 127, BP 100/80, RR 20, SaO2 99%
❖ Refuses examination of legs - not deformed, swelling and redness around knee
Case 3
❖ Analgesia
❖ Bloods
❖ Imaging
❖ Antibiotics - ?which bugs
Case 4
❖ Olivia, 7 months, 2/7 cough and fever
❖ Not drinking as much
❖ Video
Case 5
❖ Ava, 2 years old, noisy breathing
❖ Dad and mum concerned there is a family history of asthma
❖ Video
Case 5
❖ How severe?
❖ Treatment options
❖ When to transfer?
Case 6
❖ Ava represents the following night with worsening breathing and fever
❖ Minimal oral intake all day
❖ 40.1C, RR 46, SaO2 94%, HR 175, BP 98/64
❖ Sitting forward on mum’s lap
Case 6
❖ How does your management change?
❖ What is going through your head?
❖ What will you prepare?
Case 7
❖ Jordan, 7 years old
❖ Fever and runny nose for 5 days, currently on amoxycillin, referred by GP as now had headache and stiff neck to assess for meningitis
❖ What do you want to know?
Case 7
❖ Other concerning symptoms
❖ Truly rigid?
❖ Antibiotic effect?
❖ LP?
Case 8
❖ 7 week infant fever with rash
❖ Born at 34 weeks, NG feeds 1/52
❖ Crying
❖ Won’t feed
Case 8
❖ How aggressive with your investigations and management?
❖ LP?