Managing childhood fever in a prehospital setting

In 2007, the National Institute for Health and Clinical Excellence (NICE) produced guidelines on feverish illness in children concentrating specifically on assessment and initial management in children under 5 years. Fever has been identified as one of the most common reasons for children to be taken to their GP or the emergency department and a principal rationale for admission to children's wards. Usually fever indicates some underlying viral or bacterial infection, which is predominantly self-limiting. However, a few are serious in nature requiring urgent treatment, such as meningitis, septicaemia, urinary tract infection and pneumonia.It is imperative that prehospital health practitioners (paramedic technicians, emergency care practitioners, nurse practitioners) have an ability to think critically about the potential aetiologies displaying this clinical feature, an understanding of current evidence-based management guidelines and a commitment to standardize practice. The aim of this article is to explore and incorporate the NICE guidelines into an appraisal of the ill child presenting with a fever, using the SOAP (subjective, objective, assessment, plan) model of assessment (Weed, 1969) for structure. Furthermore, the physiology of fever will be outlined briefly to provide baseline underpinning knowledge and understanding.

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