The average child will have eight episodes of illness associated with a fever in the first 18 months of life so it is no surprise that this is a common presenting complaint in the Emergency Department.

PAP8 – ENT

PAP19 – Sore Throat

EM Curriculum: (click to view)

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.

Traffic Light System for Identifying Risk of Serious Illness* (NICE Guidance)

Learning Outcomes from Completing the Tasks

  • Apply the NICE guidelines on the management of fever in children.

  • Identify when admission and further investigations are required in children with a fever.

  • Distinguish between different causes of sore throat and formulate an appropriate management plan for each.

LEARNING OUTCOMES FROM FACE-TO-FACE TEACHING

  • Summarise the management of fever in children.

  • Demonstrate how to recognise and manage meningitis in the Emergency Department.

  • Demonstrate how to manage urinary tract infections in the Emergency Department.

  • Recognise life threatening airway obstruction.

  • Identify various causes of ear and nose pain and treat appropriately.


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

Lightning Learning:


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.

A 6 year old boy presents with 2 days of fever and vomiting. His parents are concerned as he has been very lethargic today.
A 3 year old boy presents following an injury to his nose. He was playing with his older brother when he ran into the arm of the sofa.
For the following cases of fever without obvious focus please assign a level of risk (low, intermediate, high) and state which investigations (if any) should be performed.

ADDITIONAL RESOURCES

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

Management of meningococcal disease in children and young people

An excellent one page document covering the acute presentation and management. This is published by the Meningitis Research Foundation in association with NICE.

Management of bacterial meningitis in children and young people

An excellent one page document covering the acute presentation and management. This is published by the Meningitis Research Foundation in association with NICE.


COURSE FEEDBACK

Once you have worked through the exercises, discussed the example cases and attended the face-to-face teaching, please complete the following form: