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Pediatric Fever

2/21/2014

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Picture
Dr. Stacey Reynolds - Pediatric Fever

    0-28 days - don't overthink it!  - full work up

    29-90 days - to tap or not to tap? 

     > If low risk 
        - well appearing child full term with normal physical exam without evidence of focal bacteria infection -             then blood cultures, UA (don't trust the dip)
        - if meets low risk criteria - can either choose to not tap & DC w/o antibiotics or tap, 
        - if no pleocytosis, give dose of abx and DC home (if reliable parents)

    3-36 months - does fever exceed 102.5? If not, no further testing is needed!!

         > Does patient have an obvious source of fever?  if so treat.  If not & febrile > 102.5 test

         > UTI
            - Test all with high risk (prior UTI, high grade VUR, renal abnl); uncircumcised male < 1,circumcised male < 6 months, females                 < 2 yrs

         > Bacteremia  
            - If less then 2 prevnar (meaning 2 shots, then 2 weeks after 2nd set of shots) test - CBC,
                blood cultures - if WBC > 15K, ANC >10K, treat with ceftriaxone
            - If > 2 prevnar blood cultures at MD's discretion

            - If hyperpyrexia (temp of 106 or above) blood cultures at MD's discretion
              (based on small study that showed 10% bacteremia in hyperthermic kids - this was pre Prevnar)

         > PNA - CXR only needed if evidence of lower respiratory symptoms, hypoxemia, persistent
            fever, T over 103, WBC > 20K

> Herpes - we overtest! (only 2% of what we send comes back positive

> 60 day old febrile kid with + UA - to tap or not - data is still out

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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • Global EM
    • Toxicology
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • MATCH 2022
    • Alumni
  • STUDENTS/APPLICANTS
    • Prospective Visiting Students
    • Healthcare Disparities Externship
    • UNC/Wake Forest Students
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction
    • Evaluations/Interview Season