PEM Fellow’s Conference 12/17/14: Improving Fever Management in the Peds ED Rob Cloutier, MD, MCR.

PEM Fellow’s Conference 12/17/14: Improving Fever Management in the Peds EDRob Cloutier, MD, MCR

GoalsDiscuss literature and issues related to the practice

of Pediatric EM

Use collective knowledge of the literature to inform case based problems.

East Coast rules apply. Literature ‘knife fights’ not only tolerated but encouraged

Questions

Fever, the what and why?

Fact vs. Fiction?

Evidence vs. Expectations?

Harm vs. Benefit?

What does a ‘Best Practice’ for Fever Management look like?

Case #118 month old male brought in for fever of ‘107’.

Patient has URI symptoms, but is smiling as he gets his popsicle and has a temp in the ED of 37.8. Mother states she gave 0.8 cc’s of the left over Infant Tylenol before coming to the ED but that ‘it never works’. The real reason she came though was because the patient’s grandmother’s aunt Betsy had a friend Jane who’s bother Joe had a fever of 108 in 1959 and ‘he got brain damage from it…poor Joe’

What does great fever management look like?Know facts vs. myth completely.

Reassurance = Education

Look at the whole patient – make sure vitals fit and pertinent negatives are accounted for.

Work off appearance and not a number

Case #2 Mother presents to the ED with her 18 month old child who

had a fever at home of 101 axillary and in the ED has a temperature of 38.9 orally. The child is well appearing but is also not eating well. The mother gave Tylenol at home. Mom is scared she will have a seizure and that she has meningitis.