Description
Fever management in pediatric emergencies involves prompt assessment to determine the underlying cause and severity. Accurate temperature measurement is essential for guiding treatment decisions. Antipyretics like acetaminophen or ibuprofen are commonly used to reduce fever and alleviate discomfort. Monitoring for signs of serious illness, such as meningitis or sepsis, is crucial for timely intervention. Educating caregivers on fever management and when to seek medical help ensures better outcomes for pediatric patients.
Résumé
- Fever is a common symptom in children, accounting for a significant percentage of pediatric emergency room visits. While concerning, it's crucial to remember fever itself is not a disease, but rather a sign of an underlying issue that needs to be identified.
- Accurate temperature measurement is essential. Rectal or axillary (armpit) readings are generally preferred in children, avoiding oral measurements. Fever without a source signifies an acute febrile illness where the cause is not readily apparent after initial examination.
- The causes of fever can be varied, encompassing environmental factors, infections (most commonly viral), inflammatory conditions, immune-mediated responses, and neurogenic issues affecting the body's temperature regulation. A thorough history and physical examination are crucial in forming a differential diagnosis.
- Differentiating between bacterial and viral infections can be challenging but helpful. Bacterial infections often present with a child appearing sicker from the outset, while in viral infections, the child may be active and playful between fever episodes. Blood cultures should be obtained before initiating antibiotic therapy.
- Bacteremia (bacteria in the blood) is a serious concern, especially in infants under 3 months, requiring prompt investigation and treatment. Urinary tract infections are also a common cause of fever and require urine analysis for diagnosis.
- Antibiotic use should adhere to established guidelines, favoring single, effective antibiotics with minimal doses and avoiding broad-spectrum options when specific sensitivities are known. Meningococcal infection, though rare, poses a high risk.
- The severity of fever doesn't always correlate with the seriousness of the underlying condition. Temperatures up to 104°F (40°C) can often be managed safely with antipyretics like paracetamol (acetaminophen) and sponging. Ibuprofen's potential to interfere with the inflammatory process makes paracetamol the preferred antipyretic.
- Assess a child's overall condition, following the ABCDE approach (airway, breathing, circulation, disability, exposure). Consider parental concerns, as they often have valuable insights into the child's behavior and health. Infants under 3 months may not present with typical fever patterns due to immature temperature regulation.
- While leukocytosis (elevated white blood cell count) is often associated with bacterial infections, viral infections can also cause it. Elevated inflammatory markers (ESR, CRP, procalcitonin) indicate inflammation but not necessarily infection.
- Fever doesn't automatically warrant a chest X-ray, unless respiratory symptoms are present. Consider urine analysis in cases of dysuria, hesitancy, or other urinary symptoms. Remember, fever management focuses on addressing the underlying cause, not just suppressing the temperature.
- Vaccination programs have led to a decrease in certain infectious causes of fever. Proper counseling of parents is essential, emphasizing the importance of follow-up and recognizing signs that warrant immediate medical attention.
- Clinical judgment, encompassing the child's general appearance, temperature, and leukocyte count, remains crucial in evaluating fever. Recognize that infants under 3 months are at higher risk for serious bacterial infections like Group B Streptococcus.
- Take home messages are: fever is a symptom, not a disease; find the cause of the fever; focus on food and water balance to prevent dehydration and provide emergency numbers so there is a means of contacting a medical professional.
Exemple de certificat
À propos des intervenants
Dr Vishal Parmar
Anciens élèves du Collège royal de pédiatrie et de santé infantile
Divulgation financière
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