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Febrile child (Aetiology (Iatrogenic Post-vaccination fever, Infection …

- - - - Activity
        Abnormal response
        Reduced activity
        Prolonged stimulation to waken
      - Breathing
        Nasal flaring
        Tachypnoea (RR >50 6-12m; >40 >1y)
        Low O2 sats (<95% air)
        Chest crackles
      - Colour
        Pallor (rep by parents)
      - Hydration
        Dry mucous membranes
        Poor feeding
        Reduced UO
        CRT>3s
      - Other
        Fever >5d
        Swelling of limb/joint
        Non-weight bearing
        New lump >3cm
    - - Colour
        Pale, mottled, ashy, blue
      - Activity
        Unresponsive, barely rousable
        Weak. high-pitched or continual cry
      - Breathing
        Grunting
        Severe distress
      - Hydration
        Reduced skin turgor
      - Other
        Non-blanching rash
        Bulging fontanelle
        Neck stiffness
        Seizures, focal signs
        Bilious vomiting
    - - Activity
        Normal response
        Content, smiling
        Alert or wakens quickly if roused
        Strong normal cry
      - Colour
        Normal skin, lips, tongue
      - Breathing
        Normal
      - Hydration
        Normal
      - Other
        Generally normal
        No fever on examination
- - - - Conservative
        
        Admission
        ADMIT
        Identify source
      - Medical
        
        Abx
        Indication: fever + shock/coma or signs of mening disease;
        likely N mening, S pneum, S aureus, Hib or E Coli infection
        E.g. high dose 3rd gen cephalosporin (e.g. cefotaxime)
        
        Antivirals
        Indication: suspected HSV encephalitis
        E.g. aciclovir
        
        Corticosteroids
        Indication: suspected bacterial meningitis
        CI: age <3m
        
        Antipyretics
        E.g. paracetamol, ibuprofen
    - - Conservative
        
        Admission
        Only if parental anxiety, social circumstances,
        contact with serious illness, risk of tropical disease
        
        Safety netting
        Check on them during the night
        Keep them off school while feverish
        Look for signs of dehydration (if present, seek help)
        Offer regular drinks (if stop, seek help)
        drinks, check for non-blanching rash (if present, seek help)
        Don't sponge with water
        If seizures, seek help
        If fever >5d, seek help