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APPROACH TO A CHILD

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Tachypnea, chest retractions or grunting. Signs of Shock : ... Chest retraction, grunt, stridor. Look. Meningeal signs. ENT. Abdominal distension. Spleen, liver ... – PowerPoint PPT presentation

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Title: APPROACH TO A CHILD


1
APPROACH TO A CHILD WITH FEVER
2
FEVER THE FIRST SEVEN DAYS
  • Fever is defined as an elevation of body
    temperature above normal and represents an
    important defense mechanism of our body
  • Needs to have been reliably documented
  • Diurnal Variation / circadian rhythm

3
Mechanism of fever
ENDOGENOUS PYROGENS IL-1 / IL-6 /TNFa/IFN
EXOGENOUS PYROGENS
PG
HYPOTHALAMUS
PG-E2
ELEVATED THERMOSTAT
FEVER
4
TYPES OF FEVER
  • CONTINUOUS / SUSTAINED
  • INTERMITTENT
  • REMITTENT
  • TERTIAN
  • QUARTAN
  • BIPHASIC

5
Red Flags
  • Change in behavior
  • Irritability
  • Drowsiness or reduced alertness
  • Tachypnea, chest retractions or grunting
  • Signs of Shock
  • Disproportionate tachycardia or tachypnea
  • Delayed capillary refill
  • Reduced urine output
  • Core-Skin temperature difference

6
Red Flags
  • Membrane over the tonsils
  • Fever in a neonate
  • Hyper-pyrexia Temperature exceeding 106º C
  • Purpura, Petechie and Ecchymoses
  • Known predisposing condition or illness VP
    shunt, cardiac disease, immunodeficiency state,
    rheumatologic conditions e.g. Lupus

7
Most Common Causes
  • Upper airway infection - Viral / Bacterial
  • Gastroenteritis
  • Malaria
  • Viral exanthems
  • Viral hepatitis
  • Pneumonia
  • Typhoid

8
Less Common Causes
  • Urinary Tract infection
  • Tuberculosis
  • Meningitis
  • Dengue
  • Leptospirosis
  • Diphtheria

9
Non-infectious Conditions
  • Kawasaki Disease
  • Acute leukemia

10
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11
EVALUATION
12
Ask
  • Age
  • Onset
  • Duration
  • Progress
  • Inter-febrile state
  • Response to antipyretic
  • Accompanying (localizing) symptoms
  • Contact with similar illness or past history of
    infective focus

13
Look
  • Sick or ill-looking
  • Alertness
  • Core-skin temperature difference, capillary
    refill time
  • Heart rate, respiratory rate
  • Chest retraction, grunt, stridor

14
Look
  • Meningeal signs
  • ENT
  • Abdominal distension
  • Spleen, liver
  • No abnormality detected on clinical examination
    or history

15
Perform
  • Perform relevant tests if there is clinical
    localization of symptoms and signs
  • When no localizing manifestations are present,
    the following investigations may be useful
  • Infants Hemogram, urinalysis, chest
    radiograph
  • Older children Hemogram, blood culture

16
FEVER THE FIRST SEVEN DAYS
No localizing manifestations
Non-toxic
Toxic
Viral Fever Malaria
Typhoid Urinary Tract infection
17
FEVER THE FIRST SEVEN DAYS
With Localizing Manifestations
Nasal discharge Tonsillar Follicles Palatal
petichiae
Tachypnea Chest signs
Loose stools
Urinary cts.
URTI
PNEUMONIA
ACUTE G.E
UTI
18
(No Transcript)
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