Pediatric emergency medicine trisk 0653 0653
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Evaluation of the Child With Fever
'f
Triage
Sepsis Screen
Recent Travel Screen
Infectious Disease Exposure Screen
Isolation & Infection Control
Considerations
Sepsis Screen Positive
Host Compromise Considerations
History and Physical
Determine Signs Symptoms of
Suspected/Recognizable Bacterial or Viral Infection
.
No Obvious Source or
Possible Nonspecific
Viral Infection
'
>
1
Age >56 days -24 months
Evaluate UTI risk factors
Consider occult pneumonia
Immunizations Status
Suspected/Recognizable
Bacterial or Viral Infection
1
Bedside team huddle with rapid
evaluation and treatment, including
support, and provision
of broad-
spectrum antibiotics
Febrile Young Infants
Oncology Patient
> Sickle Cell Disease
Central Line Presence
Ventriculoperitoneal Shunt Presence
Other Host Compromise
Signs of Severe Infection
Other Considerations
Immunization Status
Unusual Exposures
Fever of Unknown Origin
International Traveler
Kawasaki disease
Nonlnfectious Etiologies
Age >24 months
History and physical-directed
evaluation
'
Treatment
Supportive care for most viral illnesses
Consider Influenza Season/Treatment Indications
Antibiotics for Focal Bacterial Infections
- Consider Local Antibiotic Resistance Patterns
Disposition
Discharge
Admission
Assure adequate hydration and appropriate vital signs
Specific discharge instructions by illness
Fever supportive care
Follow- up recommendations and return precautions
FIGURE 31.1 Algorithm for the evaluation and treatment of the febrile child. (Adapted from
pathway by authors K. Cohn, MD, MPH; F. Balamuth, MD, PhD; R. Marchese, MD; F.
Henretig, MD; J. Gerber, MD, PhD.)
Some febrile exanthems are characteristic enough to be diagnostic (see Chapter
70 Rash: Papulosquamous Eruptions and Viral Exanthems ). Varicella, rubeola,
scarlet fever, and coxsackievirus can all be identified by their pathognomonic
rashes. However, if a child with chickenpox presents several days into the illness
with a new fever, the possibility of group A β-hemolytic streptococcal or
Staphylococcus aureus superinfection should be considered. Children with fever
and petechiae may have invasive meningococcal disease, disseminated
streptococcal infection, or Rocky Mountain spotted fever; however, they may
