case study:

Zara, age 4 Zara has been booked into one of your emergency appointment slots this morning. Mum reports that she has had a high temperature for the past three days, levels being 38°C. What else would

you like to know? She has had a cough and coryza, but no history of vomiting nor rash. History reveals no obvious focus for infection apart from her respiratory tract. Her past medical history is unremarkable, with no recent travel nor vaccinations. Mum has been giving her paracetamol to lower her temperature, which has helped temporarily, but the temperature recurs – and this is mum’s main concern. She is spending a lot of time sleeping, is not interested in play, and her appetite is poor, though she is drinking plenty of fluids. On examination, her tympanic temperature is 38.8°C, pulse 140, resp rate 22/min, capillary refill time

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