Fever, Painful Ear, Sore Throat, Dizziness & Vertigo [Case #1]

“A mother brings her 2 year old son to the emergency department, he has been hot and clingy all day.”

Has been off his food but had no vomiting or diarrhoea. He may have had a bit of a cough and snuffle but no clear features of an URTI. At one point his mum measured a temperature of 39.6°C.

On Examination

A: Patent

B: Bilateral air ENT with no added sounds, RR: 35 , Sats 97% (21%)

C: HR: 109 , CRT: 3s (sternum), peripheries warm

D: Clingy to mum, but cries if examined and will interact with parents. BM 5.6

E: Slightly mottled, no obvious rashes. T: 38.2°C. Slightly enlarged tonsils but no exudate and normal tympanic membranes bilaterally. He weighs 12 Kg.

Questions

Answer one question before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. The first part of teaching will be spent discussing this case:

1. Does the exact height of a fever have a clinical bearing?

2. What are the five domains assessed in the NICE traffic light system for identifying risk of serious illness?

3. Based on the initial examination where does this child fit into the traffic light system?

4. Outline three steps you would take in the management of this child (you may include investigations or treatments).

5. Give the correct dose of paracetamol and ibuprofen for this child?

6. Assuming the child had had no concerning features and you identified a source what advice would you give to the parents on discharge?

7. If he had had a febrile convulsion prior to arrival, how would your management change?