Pediatric: Fever/Infection

 

History:

 

  • Age
  • Duration of fever
  • Severity of fever
  • Past medical history
  • Medications
  • Immunocompromised
  • Transplant
  • HIV
  • Diabetes
  • Cancer
  • Environmental exposure
  • Last Acetaminophen or Ibuprofen

 

Significant Findings:

 

  • Warm
  • Flushed
  • Sweaty
  • Chills/rigors

 

Associated Symptoms (Helpful to localize source)

 

  • Myalgia
  • Chest pain
  • Cough
  • Headache
  • Dysuria
  • Mental status changes
  • Rash
  • Abdominal pain

 

Differential:

 

  • Infections/sepsis
  • Cancer/tumors/lymphomas
  • Medication/drug reaction
  • Connective tissue disease
  • Arthritis
  • Vasculitis
  • Hyperthyroidism
  • Heat stroke
  • Meningitis

 

Contact, droplet, and airborne precautions

 

Treatment:

 

 

 

  • Oxygen

 

 

 

 

 

 

  • Initiate IV

 

Temperature >100.4⁰F (38 ⁰C); if awake and no risk for aspiration ?

 

  • Yes

 

 

 

 

  • No

 

    • Notify receiving facility or contact Medical Control

 

PEARLS:

 

  • Pediatric =
    • 1 day to less than age 12, or
    • less than 55 kg in ages 13-18.
  • Use Broselow tape for pediatric drug dosages.
  • Acetaminophen quick calculation:
    • Weight in kg/2 = dose in mL.
  • Febrile seizures are more likely in children with a history of febrile seizures and with a rapid elevation in temperature.
  • Patients with a history of liver failure should not receive Acetaminophen (Tylenol).
  • Droplet precautions include:
    • standard PPE
    • standard surgical mask for providers who accompany patients in the back of the ambulance
    • surgical mask or non-rebreather O2 mask for the patient.
  • This level of precaution should be utilized when:
    • influenza
    • meningitis
    • mumps
    • streptococcal pharyngitis
    • and other illnesses spread via large particle droplets are suspected.
  • A patient with a potentially infectious rash should be treated with droplet precautions.
  • Airborne precautions include:
    • standard PPE
    • utilization of a gown
    • change of gloves after every patient contact
    • strict hand washing precautions
  • This level of precaution should be utilized when:
    • multi-drug resistant organisms
      • (i.e., MRSA)
      • scabies
      • zoster (shingles)
      • or other illnesses spread by contact are suspected.
  • All-hazards precautions include:
    • standard PPE
    • airborne precautions
    • contact precautions
  • This level of precaution is utilized during:
    •  the initial phases of an outbreak
    • when the etiology of the infection is unknown or
    • when the causative agent is found to be highly contagious (i.e., SARS).
  • Rehydration with fluids increases the patients ability to sweat and improves heat loss.
  • All patients should have drug allergies documented prior to administering pain medications.
  • NSAID's should not be used in the setting of environmental heat emergencies.

NREMR

National Registry Emergency Medical Responder

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NRP

National Registry Paramedic