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Fever work-up in COVID era

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Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

Your emergency medicine colleague has a 7mo old, immunized, well-appearing, no PMH, with a fever of 40 C and no other symptoms. They have been scrupulously self-isolating, wiping down packages, etc. Your colleague has adhered to maximal PPE use including using N95s usually at work. No one around the child has been symptomatic. Your colleague asks what work-up you suggest in this era of COVID.

Work-up for febrile well-appearing 7mo in COVID times?

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pemsou5_wp • July 17, 2020

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  1. Kelly July 18, 2020 - 10:42 pm Reply

    Children become infected with COVID-19 similarly to adults, but tend to have milder disease. Most children are infected by an adult household member rather than vice versa (at this point – if schools open?). At this time, Uptodate recommends testing for children with symptoms consistent with COVID-19 and: immune-compromising condition, chronic cardiac or pulmonary disease, former preterm infants, neuromuscular disease with airway clearance difficulties, poorly controlled type 1 DM, severe obesity, known contact with COVID+ individual in last 14 days, or severe symptoms. Individual parents must balance their concern for COVID and UTI with their desire to avoid bringing their child into an acute healthcare facility.

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