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4 Cards in this Set
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- Back
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What do you do with a child under 60 days and a fever >38C
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Get urine, blood, CSF, IV access, give ampicillin and cefotaxime or gentamicin. Consider acyclovir. Admit.
IF ILL APPEARING, GIVE ANTIBIOTICS ASAP. DO NOT DELAY FOR DIAGNOSTICS TESTS Serious bacterial infection in ~12% |
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What do you do with a 61-90 day year old child with a fever >38C?
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Philadelphia Criteria
-Normal clinical appearance -Peripheral WBC count < 15 x 10^9 /L -Band to neutrophil ratio < 0.2 -UA with < 10 WBC's/HPF and no bacteria on brightfield microscopy -CSF with < 8 WBC's/μL and a negative gram stain (can be deferred if well appearing at 61 days). -No evidence of infiltrate on chest x-ray if respiratory sx -Stool negative for occult blood If all tests negative, D/C home with good follow up (pcp, telephone, parental comprehension, and access to transportation), no antibiotics If positive, admit and treat with third generation cephalosporin until culture results are available Can consider using these criteria for infants 29-60 days (approved by AAP but not ACEP). |
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What do you do with a 3 - 36 month old child with a temperature of 39C?
- If well appearing? - If ill appearing? - If immunized? - If an uncirmcumsized male? |
If well appearing and fully immunized against HiB and Pneumonia.
-obtain bagged UA in females <2yr, males<6mo, and uncircumsized <2yr. If ill appearing admit and treat If not immunized: - bagged UA and CBC, consider CSF if ill appearing or clinical suspicion |
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Most common infections in
- 0 to 28 day - 29 to 90 |
-viral most common
-UTI most common bacterial for all groups 0-28d: GBS, ecoli, listeria, other gnr, congenital hsv 29-90d: S. pneumo, Ecoli |
