Paediatric Acute care Guidelines PMH Emergency Department

Assessment

Investigations

  • The majority of children have mild disease and require no investigations 
  • Indicated only if systemic symptoms, suspicion of underlying infection or in immunocompromised patient
    • FBC, CRP and Blood cultures are indicated in the unwell child who appears septic

Management 

Cervical lymphadenitis (acute)

 Reactive Lymph Node (LN) 

  • Nodes are usually small, discrete, mildly or non tender
  • LN are most commonly reactive due to viral URTI and may persist for some weeks 
  • Management is expectant with clinical review by GP

Acute Bacterial Cervical Lymphadenitis 

  • Large (>1cm), discrete, tender cervical LN +/- overlying cellulitis
  • Usually anterolateral neck, may have scalp or dental source
  • Antibiotics – Skin, Soft Tissue and Orthopaedic Infections ChAMP Empiric Guidelines
  • Abscess requires surgical review for incision and drainage
  • In lesions that persist for more than 2 weeks, consider atypical pathogens such as non-tuberculous mycobacteria, Bartonella henselae or non-infectious conditions. 

Nursing 

  • Apply emla if patient condition is suggestive of requiring intravenous antibiotics

Observations

  • Baseline observations include heart rate, respiratory rate, oxygen saturations and temperature.
  • Minimum of hourly observations should be recorded whilst in the emergency department.
  • Any significant changes should be reported immediately to the medical team.

References

  1. WA Health Child and Adolescent Health Service. Skin, Soft Tissue and Orthopaedic Infections ChAMP Empiric Guidelines Version 2, August 2014

External Review: Christopher Blyth (Infectious Diseases Consultant) September 2015

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