Emergency Department Management of Rash and Fever in the Pediatric Patient

Points & Pearls Excerpt

• Examine the patient for nondermatologic findings, such as lymphadenopathy, abdominal pain, arthritis, and cardiac murmurs, that may correlate with certain etiologies.
• Immediately place patients with suspected measles on airborne precautions, including a negative pressure room, and N-95 respirators for the healthcare staff.
• Treat patients with an acute case of measles, especially immunocompromised patients, with vitamin A to decrease the risk of associated complications, such as pneumonia, hearing loss, blindness, or death.
• Use the revised Jones criteria to diagnosis acute rheumatic fever, in addition to ordering a CBC, ESR, CRP, ASO, ECG, and echocardiogram.
• Order aspirin or naproxen for carditis in acute rheumatic fever. Consider corticosteroids in addi-tion to IVIG in patients with moderate to severe carditis.

Most Important References

• Aber C, Alvarez Connelly E, Schachner LA. Fever and rash in a child: when to worry? Pediatr Ann. 2007;36(1):30-38. (Review)
• Dyer JA. Childhood viral exanthems. Pediatr Ann. 2007;36(1):21-29. (Review)
• McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation. 2017;135(17):e927-e999. (Practice guideline)
• Gottlieb M, Long B, Koyfman A. The evaluation and management of toxic shock syndrome in the emergency department: a review of the literature. J Emerg Med. 2018;54(6):807-814. (Review)
• Waterfield T, Lyttle MD, Fairley D, et al. The “Petechiae in children” (PiC) study: evaluating potential clinical decision rules for the management of feverish children with non-blanching rashes, including the role of point of care testing for procalcitonin & Neisseria meningitidis DNA- a study protocol. BMC Pediatr. 2018;18(1):246. (Prospective diagnostic accuracy study)