1 / 4

FEVER WITHOUT A SOURCE > 100.4 RECTAL

FEVER WITHOUT A SOURCE > 100.4 RECTAL. < 28 DAYS. 29 DAYS – 2 MONTHS. WBC <5 or >15 Band/ Neut >0.2 CSF > 8 WBCs UA > 10 WBCs Stool WBCs/heme CXR. WBC <5 or >15 Band/ Neut >0.2 CSF > 8 WBCs UA > 10 WBCs Stool WBCs/heme CXR if indicated. Anything in w/u +.

questa
Download Presentation

FEVER WITHOUT A SOURCE > 100.4 RECTAL

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. FEVER WITHOUT A SOURCE > 100.4 RECTAL < 28 DAYS 29 DAYS – 2 MONTHS WBC <5 or >15 Band/Neut >0.2 CSF > 8 WBCs UA > 10 WBCs Stool WBCs/heme CXR WBC <5 or >15 Band/Neut >0.2 CSF > 8 WBCs UA > 10 WBCs Stool WBCs/heme CXR if indicated Anything in w/u + Everything in w/uneg Parents Reliable Pediatrician f/u next day Well appearing pt Antibiotics Antibiotics * ADMIT D/C * Provider preference: Home with NO antibiotics or first dose Rocephin if LP was preformed; or obs pt for 1st 24hrs for blood/csf culture neg All urine is cathed! All temps are rectal

  2. *FUS > 100.4 *Most PEM providers define FUS > 102.2 after 2mos 2 – 3 MONTHS WBC - wnl UA - wnl WBC - wnl UA > 10 wbc WBC <5 or >15 UA > 10 wbc WBC <5 or >15 UA - norm Stool > 5 WBCs/heme CBC and UA + or Neg Parents Reliable Pediatrician f/u Well appearing pt LP & Blood Cx LP & Blood Cx LP & Blood Cx Ceftriaxone and strongly consider OBS for blood & CSF cxneg for 24hrs Ceftriaxone and strongly consider OBS for blood & CSF cxneg for 24hrs • Ceftriaxoneonce if • Parents Reliable • Pediatrician f/u next day • Well appearing pt • Ceftriaxone once and initiate outpatient UTI abx & valve w/u if: • Parents Reliable • Pediatrician f/u next day • Well appearing pt Discharge with next day follow up and NO antibiotics! OBS and hold antibiotics until stool studies return unless indication to treat blood or urine OR OR

  3. FUS > 102.2 3 – 6 MONTHS Ill Appearing YES NO UA Treat if + YES WBC <5 or >15 Band/Neut >0.2 CSF > 8 UA > 10 WBCs Stool > 5 WBCs/heme CXR if indicated Source Identified? NO • Treat Urine if + • Check CBC: send Blood Culture if CBC + one dose of Ceftriaxone is MD choice. Conservative Approach ADMIT D/C

  4. Accepted Fever Sources HSV/Gingivostomatits Herpangina/Ulcerative Stomatits RSV Croup Flu Varicella Viral Exanthum (rash) Enteroviruscoxsackie HFM dz, echo, rhino, entero, • Treatment Doses • <28 Days: • Acyclovir = 60mg/kg/day divided q 8 hrs • Ampicillin = 50mg/kg • Gentamicin = dose is age dependent (use less than 8 days) • Cefotaxime = 50mg/kg (use if > 8 days) • Vacnyomycin = 15-20mg/kg • 29 Days – 6mos • Ceftriaxone = 50mg/kg

More Related