Fever, Sore Throat & ENT

BACKGROUND

Infection remains the leading cause of death in children under the age of 5 years and fever comes second only to breathing difficulty as the commonest cause for hospital admission in children.

The majority of children presenting to the ED with fever will have a minor, self-limiting viral illness.

However, a small proportion will have more serious pathology and it is important to be competent in history taking and examination of children of all ages, and to be vigilant in looking for the 'red flags' to ensure these children are recognised and treated appropriately.

Many children both with and without fever present to the ED with ENT symptoms including earache, runny nose and sore throat. Again the vast majority will have a minor, self-limiting illness but there are a few important diagnoses that should not be missed.

The curriculum also make reference to Kawasaki disease which although it is not common is associated with long term consequences and therefore important for the ED doctors to be aware of.

The NICE guidance Feverish illness in children includes a useful table of serious diagnoses to consider when assessing any child who is unwell with a fever.

Learning Outcomes from Completing the Tasks

LEARNING OUTCOMES FROM FACE-TO-FACE TEACHING

Tasks

Complete the following before the face to face session:

Task 1: Clinical assessment of fever

Duration: 60 mins

Once you have logged into Spotting the Sick Child website complete the whole section on Fever. This section takes you through some essential knowledge and skills required to assess feverish children in the Emergency Department. Spotting the Sick Child – Fever

Task 2: Feverish illness in Children

Duration: 10 mins

This short video from the RCEM FOAMed Network covers the NICE guideline relevant to feverish illness. It includes:

• how to measure temperature,

• the relevance of reported fever by parents (or carers) 

• the traffic light system for risk of serious bacterial infection (SBI)

• some of the management steps to be taken in the shocked child

• when to consider Kawasaki's Disease

• use of antipyretics

Task 3: Sore Throat

Duration: 60 mins

This module on sore throats covers both paediatric and adult cases. It covers the various differentials and investigations in sore throat. It is from the new RCEM Learning website, if you haven't been to the site before take a minute or two and have a look around at the other content - it's curriculum mapped and all for free! RCEM Learning module: Acute Sore Throat

Task 4: Foreign Body Removal

Duration: 8 mins

This is a humorous look at foreign bodies in the throat, it covers:

• the relevant anatomy

• points to consider when taking a history

• examination technique

• possible removal in the ED.

• what to look for on lateral x-ray

• differentials to consider

It is part of a series of videos available on youtube, it may be worth exploring some of their other videos on ENT topics.

#EM3 Content

CASE DISCUSSION

Click on the following link to access and edit the Wiki case related to this teaching module. You are expected to answer one question each before attending the face-to-face teaching session. Please add comments to the answers already given if you think it's appropriate. The first part of teaching will be spent discussing the case.

ADDITIONAL RESOURCES

Here are some extra resources that offer further insight into this module:

COURSE FEEDBACK