febrile illness in children l.
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Febrile Illness in Children. Aims of NICE?. Guidelines for individual conditions Generalized guideline for unwell child Patient centered Take on board parental concerns. Priorities. Fever detection Risk stratify with traffic light system <4/52 – axilla >4/52 to 5yrs – axilla or tympanic

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Presentation Transcript
aims of nice
Aims of NICE?
  • Guidelines for individual conditions
  • Generalized guideline for unwell child
  • Patient centered
  • Take on board parental concerns
priorities
Priorities
  • Fever detection
    • Risk stratify with traffic light system
    • <4/52 – axilla
    • >4/52 to 5yrs – axilla or tympanic
    • Forehead thermometers unreliable
priorities5
Priorities
  • Other observations
    • Heart rate
    • Respiratory rate
    • Capillary refill time
  • Red flag features
    • Assessment <2hrs by Pediatricians
green
Green
  • Strong cry / not crying
  • Content / smiles
  • Awake
  • Normal colour - skin, lips & tongue
  • Moist mucous membranes
  • Normal response socially
amber
Amber
  • Wakes only with prolonged stimulation
  • Decreased activity
  • Poor feeding (infants)
  • Absent social responses
  • Dry mucous membranes
  • Reduced urine output
  • New lump larger than 2 cm
  • Pallor
  • Nasal flaring
slide9
Red
  • Unable to rouse / does not stay awake
  • Weak, high-pitched cry
  • pale/mottled/blue/ashen
  • Reduced skin turgor
  • Bile-stained vomiting
  • Chest recession
  • RR > 60 bpm
  • Grunting
  • Bulging fontanelle
  • Appears ill
  • <3/12 + temp ≥38°C
  • 3–6 months + temp ≥ 39°C
management
Management

GREEN

MANAGE AT

HOME

management18
Management

AMBER

Written advice

SAFTEY NET

Follow up

Hand over to OOH

management19
Management

RED

URGENT

REFERRAL

Less than 2 hours

other recommendations
Other Recommendations
  • Parent education
    • Hydration & assessment for dehydration
    • Adverse signs
    • Observation through night
    • What to do in emergency
other recommendations21
Other Recommendations
  • Don’t prescribe abx without source
  • LRTI/suspected pneumonia ≠ CXR
  • Separate UTI guidelines
  • Meningococcal disease
    • Early abx