Having you had trouble seeing a pediatric patient’s tympanic membrane because of impacted cerumen? Scared from that last time you used a rigid curette and caused bleeding in the ear canal? The parents are worried that you hit the brain…
Kawasaki Disease can be easy to diagnose when you have the pediatric patient, who presents with all 5 of the classic clinical findings. What happens when you have the prerequisite fever for ≥5 days, but only 2-3 clinical criteria?
- What ARE the 5 classic findings?
- When do you do waitful watching?
- When do you perform an echo?
- When do you treat empirically?
Check out the nice flowchart below which addresses these questions. They summarize the most recent (2004) American Heart Association’s consensus group’s recommendations.
In part 2 of this “Pediatric Fever Without a Source” Paucis Verbis cards, we now cover febrile infants aged 29 days to 3 months (PV card for birth-28 days). Note that there is no single correct answer in how to manage these patients. There can be a wide variation in practices, partly because of the slightly different criteria used by the 3 studies. The overarching principle is that “high risk” infants get admitted with IV ceftriaxone and “low risk” infants get discharged with close follow-up +/- a ceftriaxone IV or IM dose. The line between these two risk categories is the grey area.
Pediatric patients commonly are brought to the Emergency Department for a fever without a source. Management of these patients depends on the patient’s age. Today’s PV card focuses on the youngest age group: Birth-to-28 days.
Performing a physical exam on frightened pediatric patients can often be challenging. I am always thrilled to add more child-whisperer techniques to my arsenal of tricks. I have written in the past about:
- Balloonimals iPhone app to grossly assess peak flow
- Candleflame iPhone app to grossly assess peak flow
- Eye Handbook iPhone app with pediatric fixation animation targets
- Casting/splinting your buddy bear
What’s your trick on performing an otoscope exam of the ears?