Pediatric Problem Solving -Case 2

Pediatric Problem Solving – Case 2
A 2 week old infant develops fever, 38.9 C, vomiting, and irritability. His heart rate is 170/min, and RR is 40/min. The infants anterior fontanelle is full, but there is no nuchal (neck-related) rigidity. The rest of examination is

unremarkable.

What is the appropriate management

A. Oral fluid and follow up in 24 hr

B. Oral amoxicillin and follow up in 1 week

C. Admission to hospital for investigation and ttt

D. IM ceftriaxone and follow up in 1 week Explanation of the case

Explaination of the case
 the bulging fontanelle (full) = increased ICT. Fever, vomiting and irritability = infection
There is no neck rigidity because this sign and others like brudzinski's..etc.. are non-dependable signs in children because of the open fontanelle which offers a relief of the increased tension.
N.B.: Rule: An infant (a)febrile + (b)vomiting+ (c)irritable = admission to the hospital
N.B: if the fontanelle is depressed = dehydrated infant
 Choice A: can never be a choice in anyway

 Choice B: a) Points against: oral = management at home which is unacceptable in this case+amoxicillin is not the drug needed.
 Choice C: [the right answer
a) Points with: the infant needs to be admitted for CT, CBC, culture, IV antibiotics, follow up to avoid complications as convulsions.
 Choice D
a. Points against: patient must be admitted, so any choice other than IV antibiotics suggested by parents who might want go back home is unacceptable.