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FEBRA IN PATOLOGIA PEDIATRICACONF DR MIHAI CRAIU
CLINICA II PEDIATRIEIOMC ALFRED RUSESCU
FEBRA IN PATOLOGIA PEDIATRICAPLANUL LUCRARIIINTRODUCEREBOLI FEBRILE LA COPILTRATAMENT ANTITERMICEFECTE ADVERSECONCLUZII
FEBRA IN PATOLOGIA PEDIATRICAPLANUL LUCRARIIINTRODUCEREBOLI FEBRILE LA COPILTRATAMENT ANTITERMICEFECTE ADVERSECONCLUZII
DEFINITIE
Se defineste ca fiind febra o ascensiune a temperaturii la >38C [rectal]Valori periculoase [hipertermie] sunt considerate cele >416 CHipertermia.maligna! > 41 grade! Aici pot fi afectati centrii din trunchiul cerebral!! Aceste valori extreme nu se intalnesc in boli obisnuite, un copil cu pojar nu face asemenea temperaturi!
Temperatura corporal - valori normaleNu exist consens n ceea ce privete grania dintre temperatura corporal normal i febr
Limita superioar a normalului variaz cu vrsta: - nou nscui 38.0 C - ntre o lun i 2 luni 38.1 C - ntre 2 luni i 3 luni 38.2 C - > 3 luni 37.6 37.8 C cu cat esti mai mic cu atat esti mai caldut!! Daca stam in
Herzog L, Phillips S. Adressing concerns about fever. Clinical Pediatrics 2011; 50(5):383-390
FRECVENTAFrecventa febrei este mai mare la copil decat la adult*
3.7 episoade / an la copil [frecventa aproape dubla la cei cu varsta
Copiii fac deseori febra! [20-40% din parinti raporteaza cel putin un episod de febra pe an]
FRECVENTAFebra este cea mai frecventa cauza de prezentare a copilului la medic si a doua cauza de spitalizare [dupa bolile respiratorii cu tuse / dispnee] *.
Este cea mai frecventa cauza de prez la medic!!!Este a doua cauza de spitalizare!!dupa cazurile de boli resp cu tuse/dispnee!!
FRECVENTAFebra este cauza frecventa de prezentare in UPU *32% din cele 120.000 prezentari la UPU [Spit Regional Nottingham] au fost la copil20% din prezentati aveau febra, 48% din copiii internati aveau febra
Febra este un motiv frecvent de prezentare la CPU
Chart3
367
1386
PACIENTII CU FEBRA PREZENTATI LA CPU IOMC [367 PAC din 1753 Prezentati - esantion Ian - Nov 2012]
Sheet1
numevarstasexdomicdgtratGTteste cutanateIgER AdverseComplicatiiEozinofileAHCObs
Anastasiu M39MUTC+RA12.593
Anastasiu M41MUTC+RA12.593poz pt par caineidem 2
Ancu IEFRTC+RA17113
Andronie SG133MUAB+RAFlt/inh36141Pectus escav
Anghel DI36MRWR1394
Anghel IT83MUWR+RA25.5124.5spirofrate WR
Anghel M17MUWR+RAMonteluk9.2frate WRDermatita
Anghel V72MUWR+RA241233890/7103
Angheluta GM66FRWR17.5113
Apostol MA33FUWR1390Spasmul hohot plans
Apostol MA37FUWRMonteluk13.592Spasmul hohot plansidem 11
Ardelean A31FUWRfrate WR
Ardelean I66MUWR+RAsora WR
Asmarandei T14MUWR96
Asmarandei T15MUWR indV96idem 89
Badea A72FUWR18.5116mama astm trat cu ICS+LABAUrticarie
Badea AL60MUWR+RAMonteluk+Mometaz/nas19119spiro
Badea AL66MUWR+RAMonteluk+Mometaz/nas20121spiroCONTROLATOSA
Badea AL64MUAB+RAMonteluk+Flixo/inh+Mometaz/nas20121spiroCONTROLATOSA
Badita TN79MUWR21119687
Balanica T106MRAB27.5133
Banca V31MRTC+wheezing14.595.5
Banica AA59MRWR+RAMonteluk+Flt/nas16.8110spiro/poz acarieni3000EVOL FAVORRA severa
Barsan MI52FUWR+RAMonteluk+Flt/inh HD18104spiroRA severaidem 38Dermat4 exac in 10 luni
Barsan MI53FUWR+RAMonteluk+Flt/inh HD18104spiroidem 17Dermat
Barsan MI54FUWR+RAMonteluk+Flt/inh HD19106spiroRA severaidem 7 - 8dermat
Barsan MI55FUWR+RAMonteluk+Flt/inh19106spiroCONTROLAT - se scade doza Flt/inhRA severaidem 22. 23. 24Dermatita
Barsan MI56FUWR+RAMonteluk+Flt/inh18106spiroCONTROLATRA severaidem 23-26Dermatita
Bicher SM46MUWR+RA17.5
Botea S32MUWRnegNDermatita
Botez LA17MUWRBDP - ventilat mecanic 10 z
Brezeanu TG53MUTC+RA22115spiroNTRAHEOMALACIE1 exacerb in 5 luni
Brezeanu TG56MUTC+RA23116spiroTRAHEOMALACIEidem 28
Brezeanu TG59MUTC+RA22118CONTROLATTRAHEOMALACIEidem 31, 32
Buhnia T106MUABspiro
Buican R9MUWR+RA291%Dermat++
Buican R12MUWR+RAMonteluk291%idem 34Dermat++
Bulai L27MUWR14.593NN
Cadar R63MUWR+RA21.5116232.5O serM AB, T RA+urticarii
Calin MA71FUWR42127.5spirofrate cu RAObezitate
Calman MD63MUAB+RA26.5119.5spiro/poz acarieni+mucegaiRA severa
Cantoneru L50MUWR+RA16106
Caracuda C60FUTC+RA21.3116spiroRA severa
Ceausu IA61FUWR26118spiro10.75.6%[400]SUPRAPOND
Cernica TD56FURA18116
Chebarus AD23MUWR+RAMontelukpoz cazeinaIPLVDermat
Chebarus AD25MUWR+RAMontelukpoz cazeina42.2IPLVidem 43
Chirita S67FRAstm+RA20119.2spiro / pozNev Ota
Cioroianu EB56MUTC+RAMonteluk+Momet/nas20115spiroEVOL BUNA DE 6L
Cioroianu EB58MUWR+RAMonteluk+Mometaz/nas20115spiroNECONTROLAT - TC=WR>3/an[scor CR+]T AB M fumatidem 43
Citea M90MRTC+RAMonteluk23.5124spiro72M fumatoare
Ciucur R134MUAstm+RA
Codrea DM68MUTC+RARA severa
Cojocaru AL124MUWR+RAMonteluk47150spiro/poz acarieni>>RA severa
Coman AR66MRAB+RAMonteluk+Mometaz/nas32.5123spiro
Coman AR70MRAB+RAMonteluk+Xyzal36125spiroCONTROLATSUPRAPONDidem 48Dermat++
Constantin RCMUWR+RA26123
Constantin TA35MUWR+RAMonteluk+Mometaz/naspoz albus ou26.85%
Constantinescu S92FUAstm+RA22.512866511.4% [680]
Constantinescu S95FUAB+RAFlt/inh+Flt/nas23.5130spiroCONTROLATidem 48
Corcodel D40MUAB+RATC - N VienaNO serRA severa
Coricica AM23MUWRMonteluk10.882T SUDORII - 3413.70%repetate scaune cu sange
Cosma IA35FUWR+RAMontelukO ser
Costache MC47FUWr+TC
Costache T48MUWR+RA22122
Costan M36MURA18.5102O serDermat
Craiciu RM19MUWR indVMonteluk12.21 episod BO "dramatic"
Croitoru A27MUWR+RAMonteluk13101.7RA severa
Dane A68MUWR17.5110
Dasu M84MU4327.50%
Dinca BA158MUABICS+LABA [Seretide discus]59167spiroCONTROLAT
Dinu EA48MUWRMonteluk15105strabunica astm, matusa mat alergie polen
Dinu LC43FUTC+RA20.5107RGE
Dirla AO72MUAB+RAFlt/inhspirodepresie monteluk
Dirla AO75MUWR[exacerb]+RAFlt/inh+SABA+Deslor+Mometaz/nasspiroDepresie majora Montelukidem 51
Dirla AO75MUWR[exacerb]+RAFlt/inh+SABA+Deslor+Mometaz/nasspiroDepresie Majora Montelukidem 51 si 208
Dirla AO77MUAB+RAFlt/inh+Deslor+Mometaz/nasCONTROLATDepresie majora Montelukidem 68, 69, 70
Dobre CL55MUWR+RAMonteluk+Momet/nas14.7100.512115%RA severa
Dobrila V67MUAstm+RA24118RA severa
Dobrila V68MUAB+RAMonteluk+antihistTS 34; ECO C nRA severaidem 21
Dobrila V70MUWR+RAMonteluk+Mometaz/nas24118CONTROLATM RARA severaidem 53, 54
Dogaru CA52MUAB+RA22116poz polenuri
Donose MA51MUTC+RA17.2107.576.3VDC
Draghia AC148FRTC+RA56160spiroDermatita
Dragotoniu AE36FRWR+RAMonteluk1497.510.80%Tata & Mama RARA severaDermat
Dragotoniu AE42FRWR+RAMonteluk14.599CONTROLAT10.80%T si M RARA severaidem 78
Dumitrescu AMUWR+RA24.3120spirovar cu WRADHD?
Dumitrescu A73MUWR+RAMonteluk+Mometaz/nasspiroCONTROLAT
Dumitrescu S37MUAB+RA14.5Dermatita
Dumitriu V50MUWR+RAspiroDermat
Dumitru FC111MUAstm41138.5spiro
Duta RN62MUWR+RAMonteluk+Mometaz/nas+Ketof20114spiro>>10.90%RA severaDermatita
Duta RN66MUWR+RAMonteluk?Mometaz/nas+Ketof20.5116spiro>>CONTROLAT10.90%RA severaidem 84Dermatita ++
Enache DC47MRAstm [Ex]Mometa+Deslor+Monteluk17spiro
Filipoiu AM13FUTC10.9sora WRMACROSOM
Florea C171FUTC58.5151Obezitate
Florea V75MUAstm [Ex]+RA29128
Furdui TA48MUWR/exacerb usoaraMontelukspiro
Geambazzi AA20MRWR [Ex]MontelukPectus escav
Geambazzi AA22MRWR/exacerb usoaraMontelukEVOL >3epis WR/ansora cu WRidem 25Pectus escav
Geambazzi SP47FRWR [Ex]Monteluk
Geambazzi SP51FRWRCONTROLATidem 83
Georgescu AI61FUWR+RAMonteluk20.5115.8spirofrate WR
Georgescu MA66MRWR+RA20.5121poz mucegai18.3Polipi corzi vocale
Georgescu RA72MUWR+RAMonteluk+Flt/nasO ser
Gherghelescu I14FUWRMonteluk
Ghidrigan SC104MUAstm [Ex]+RA29.5132.5374Depresie Majora5%
Ghidrigan SC107MUAstm+RALABA+ICS29.5133spiroDepresie Majora5%
Ghincea MA136FUABspiroVCD, OBEZ
Gorgan M31FUTC+RA22
Gramescu A60FUTC20.5113.5TRAHEOMALACIE
Grecu A42FUTC+RA16.51026.2%[510]
Grigoras C67FUWR IACRS23NEFRECTOMIE PARTIALA
Grigoras C69FUWR23idem 64
Grigorgore M26FUWRDermatita
Grozavu D76MRTC+RA20115
Guzu A29MUWR+RAMontelukRA severa
Guzu A30MUWR+RAMonteluk+Flt/nasEVOL FAVOR RARA severaIDEM 58
Guzu A32MUWR+RAMonteluk+Flt/nasCONTROLATRA severaidem 75,76
Himpa T103MUAB+RAMonteluk+Mometaz/nas40138.5spiroCONTROLATRA severa
Hornoiu B27MUWR+RAMonteluk11.593
Hornoiu B31MUWR+RAMonteluk1496CONTROLATidem 97
Iacob-Ritzi A18MUWR+RAFlt/inh11.2Pectus escav
Iancu MA98FUTC+RA34139spiroHipertrofie adenoamigdaliana - operatie
Iancu MA100FUTC+RA36141spiroPubertate precoceidem 69
Ichim EG78FRTC
Ilia RV102MUWRFlt/inh32136.5
Ilia RV103MUWRFlt/inh33136.5idem 35
Ilia RV104MUWRFlt/inhEVOL FAVOR
Ilia RV105MUWRFlt/inh HDspiro
Ilie CN125MUAstm+RAMonteluk+DeslorRA severa dupa oprirea medic)idem 70
Ilie CN126MUAstm+RAMonteluk+Deslor38142spiroidem 19
Incicas A52FUAstm+RA18.5111poz mucegai>>Dermat
Ion R72FUWR+RApoz polenuri+mucegai
Ion RE20FUWRM AB
Ionescu LA27MUTC13
Ionica M54FUWR
Iordache R7MUWR767Traheomalacie
Iordachi S27MUWR[Ex]
Iordan AA56MUWR+RAMonteluk15106spiro60.2Dermat
Jurubita AA31FUWR+RAMonteluk+Flt/inh13.598IPLVDermat
Jurubita AA32FUWR+RAMonteluk+Flt/inh+Mometaz/nas13.598IPLVidem 189Dermat
Jurubita AA34FUWR+RAMonteluk+Flt/inh+Mometaz/nas14100poz cazeinaIPLVidem 115, 116Dermat
Karali A32FUTC11.590Dermat
Lacraru RP53MUAB+RAMonteluk+ketotif18.5113spiroEVOL FAVORDermat
Lambrea DMUWR35141spirovar cu WR
Lazar AL26MUWR16MACROSOM
Leanca DC10MRWRRGE
Leonte DFUAstmspirobunic decedat astm
Licu MI50MUWR15108Pectus escavidem 53
Licu MI51MUWR [Ex]15.5108Pectus escavidem 31
Licu MI52MUWR15.5108idem 31
Luca AL108FUTC40.5130VCD, SUPRAPOND
Luca AL109FUTC40.5130VCD, SUPRAPONDidem 134
Maftei MP119MUAstm+RAFlt/inh+Mometaz/nas36143Dermatita
Maftei MP120MUAB+RAFlt/inh+Mometaz/nas36143idem 89Dermatita
Maftei MP125MUAB+RAMontelukspiroCONTROLAT - se scoate doza Flt/inh
Mainov IM66MUWR+RAMonteluk+Flt/nas35.6120spiroNfrate RA+unchi WRHipertrofie adenoamigdalianaDermat
Mainov IM68MUWR+RAMonteluk+Flt/nas+Flt/inh29121spiroCONTROL MEDIOCRU - adaugat ICSO serfrate WR+ unchi WRRA severaidem 105
Mainov MI71MUAB+RAMonteluk+Flt/inh29120spiroCONTROLATfrateWR/RA+unchi WROBEZ, OASidem 147
Mainov SG40MUWR+RAMonteluk16.5102frateRA+unchi WRPectus escavatum
Mainov SG42MUWR+RAMonteluk16.2103frate WR+ unchi WRPectus escavatumidem 106
Mainov SG44MUWR+RAMonteluk16.5104CONTROLATfrateAB/RA+unchi WRPectus escavatumidem 148-149
Marin DC69MRAB+RAMonteluk18.5109spiroCONTROLATPectus escavatum
Marin EF37FUWR+RAMonteluk1599128NECONTROLAT - ADAUGAT Flt/inh+Deslor+Mometaz/nasRA severa
Marin EF38FUAB+RA1599.5spiroRA severaidem 46
Marin EF40FUAB+RAMonteluk+Flt/inh+Deslor+Mometaz/nas15.6101RA severaidem 109
Marin MA10FRWRMonteluk8.57725M RA, matusa WR
Marinescu AM35FUWR+RAMontelukCONTROLAT PARTIAL - se introd Monetaz/nas
Marin-Gogan M51MURA
Matache M21MRWRMonteluk
Matei A51MUWR+RA625.6%[493]T WR+RABDP
McCollum M87MUAB+RAFlt+Saim/inh+Mometaz/nas+Monteluk26.5132spiroEVOL FAVOR DUPA EXACERB SEVERARA severaDematita
McCollum M88MUAB+RAFlt+Saim/inh+Mometaz/nas+Monteluk26.5132spiroRA severaDematita
McCollum M88MUAB+RAFlt+Saim/inh+Mometaz/nas+Monteluk26132RA severaidem 112 si 113Dematita
Meita D101MUABFlt/inh HD29134spiro/paneluri+>>T dermat M RA
Meita D101MUABFlt/inh HD29134spiro>>EVOL FAVORT dermat M RAidem 95
Meita D103MUAB[exacerb]+RA29134spiroidem 153, 154
Mereuta R168MUAB+RA50.4164spiro/ +polen
Mereuta R168MUAB+RA50164spiroidem 86
Mihai T72MUWR+RAMonteluk20116Hipertrofie adenoamigdaliana - coblatie
Mihai T73MUWR+RAidem 98
Mirea AM150MUTC+RA56154spiroTRAHEOMALACIE, Emotiv, depresiv; teratom operat
Mirea AM151MUTC+RA56154spiroTRAHEOMALACIE, Emotiv, depresiv; teratom operatidem 218
Mirea AM152MUTC+RA56154spiroCONTROLATTRAHEOMALACIE, Emotiv, depresiv; teratom operatidem 148, 149
Mirea RMUWR
Mocanita VM60MUTC+RA
Munteanu M204FUAB+RAspiro/poz par pisicaDermatita
Munteanu M206FUAB+RAspiro/poz par pisicaidem 162Dermat
Murata A81MUWR+RAspiro
Naftan DG54MUWR+RAMonteluk+Deslor6594%T RARA severa
Naghy N69FUAB+RAFlt/inh+Mometaz/nas19.5118spiroM RARA severa2 exacerb in 5 luni
Naghy N69FUAB[exacerb]+RAFlt/inh+Mometaz/nas19.5118spiroRA severaidem 175
Naghy N70FUAB+RAFlt/inh+Mometaz/nas+Deslor20118spiroM RARA severaidem 175. 178
Naghy N71FUAB+RAMonteluk+Flt/inh+Mometaz/nas+Deslor21119spiroCONTROLATM RARA severaidem 123,124, 125
Naghy N71FUAB+RAMonteluk+Flt/inh+Mometaz/nas20119spiroCONTROLATM RARA severaidem 165-168
Neacsu P17MUTCPneumonii recurente - deficit imuniv A+G select
Neagu AF63MUWR+RA1919Pectus escavatum
Nica TA25MUWR+RAMonteluk17.2EVOL FAVORDermatita ++
Niculae AM42MUWR+RA16.5101RA severa
Niculae AM43MUWR+RAMonteluk16r adv FLTinhEVOL FAVORO CRIZA SEVERAidem 103
Niculeasa MT54FUTC+RA17
Nita-Manu MA48MUWRFlt/inh EPISODICEVOL >3epis WR/an
Novac TMUAB19.5117.8Limfom Hodgkin
Obiziuc A44MUWR+RAFlt/nas21.5112idm 57
Obiziuc A45MUWR+RAFlt/nas21.5112idem 4
Ocheana DA62MRRA17.5113poz pt acarieni2864.20%
Oprea AM55FRTC+RA21.5116spiro
Oprea EA133FRAB+RAMonteluk58144spiroCONTROLATOBEZITATE
Palos VD24MUWR
Pandaru-Rugina D15MURC10.7frate WRStridor laring cong
Pandaru-Rugina MA38MUWR+RAMonteluk16102.5spiro
Pandaru-Rugina MA40MUWR+RAMonteluk16103spiro
Pantile TC83MRWR+RAMonteluk+Flt/inh+Mometaz/nas20119spiroO ser
Pantile TC89MRAB+RAMonteluk+Flt/inh+Monetaz/nas21.5121spiroCONTROLATidem 141
Parascu A48MRWR+RA26119.5spiro284RA severa
Pascu MV99MUWR+RA37140spiro3.5%[232]T WR M WR+Dermatita
Patrascanu FR42MUTC+RAMometa+Deslor151016.2N
Paun Z30FUWR/exacerb usoarasora cu atopieDermatitaINTERNATA
Paunescu T42MUWR+RAT RA severa, M RA+urticarieDermat
Pedrazzini34MRWR+RAFlt/inh+DeslorAgit MontelukO seridem 74
Pedrazzini35MRWR+RAFlt/inh+DeslorRA severaidem 14
Petrescu DA93MUWR+RA21.5125poz acarieni780/234015%
Petrescu J36FUAstm+RAMonteluk+Flt/inh
Picu AE60FUWR16.5104.5ADHD
Pirjolescu FS64FUTC+RAMonteluk+Mometaz/nas25118CONTROLAT
Platteeuw L163MUABFlt/inh63.5180spiroConvalescent Pneumonie cu r pleurala si HRB
Polifrone SM85MUWR+RA24123.7spiro>>
Pop AF74MUWRMonteluk36131OBEZ, hiperemotiv, sechele PC
Popa M54FRWR+RA16104
Popescu A122FRWR+RAMontelukspiro
Popescu AMG88FUAB+RAFlt/inh HD+Monteluk18118spiro/ poz mucegai1256/1788RA severaastm sever
Popescu AMG90FUAB+RAFlt/inh HD+Monteluk18118spiro/poz mucegai1256CONTROLATRA severaidem 189Astm sever
Popescu EM41FUWRMonteluk13.898
Popescu R53MUTC+RA18.5105
Popescu S97MUAB+RA25125spiro808
Popescu VA105MUTC+RAMonteluk+Mometaz/nas+D330130.5232HipoCa
Posea R34MUWR+RAMonteluk+Mometaz/nas14100478Dermat
Posea R35MUWR+RAMonteluk+Mometaz/nas14101478idem 221Dermatita
Puiu CLMUWR+RA23.5119
Radu AAMUAstm+RAspiro
Radu AV158MUTC50155spirofrate TC si EIB
Radu MS37MUWR indVSUPRAPOND
Radu SA121MUTC+RA40139spiro/poz polen238frate TC si EIB
Radulescu MIFUAB+RALoratadina30134spiro25.82.48%mama RA
Radulescu MIFUABMontelukspiroidem 111
Rangu AG41FWR+RA
Rizea DC82MRTC+RA27.7128
Roman E28MUTC13
Sandulescu T85MUWR+RAMonteluk22.2120spiro84CONTROLATDermatita
Sebes LV44MUWR+RA15.5101.5IPLVDermat
Secula TI75MUWR22.3119.5bunica astmDermatita
Setareh SFUTC+RA21.5116RA severaDermat
Simion M57MUAstm+RAMonteluk+Flt/inh+Deslor16375RA severa
Sisu VC48MUWR+RA711RGEDermat
Sisu VC49MUWR+RAMonteluk17105711RA severa
Sitaru ARMRWRpoz par hamster280
Sitaru EDFRWR+RAfrate WR, sensibilizat par hamsterDermat
Sofron D90FRTC+RAMometaz/nas27128spiro6.2VCD
Stan MG41MUWR+RA14.597alergie medic - beta-lactami
Stancescu DG79MRAB20119poz pt acarieni
Stanciu A43FRWR+RA15O ser
Stancu MT94FUAB[exacerb]+RAFlt/inh HD + SABA30138spiro/poz par pisica, calNECONTROLAT - dat ICS+LABA [Symbicort]Dermat++
Stancu MT95FUAB+RASymbicort [ICS+LABA}30138spiro/poz par pisica, calCONTROLAT - scos Symbicort - ICS HD+Montelukidem 243Dermat++
Stanga AM43MUWR+RAMonteluk161025.60%Bunica RARA severa
Stanga AM46MUWR+RAMonteluk+Mometaz/nas+Deslor16104EVOL FAVOR5.60%Bunica RARA severaidem 139
Stanga AM49MUWR+RaMonteluk+Mometaz/nas17107CONTROLAT5.60%Bunica RARA severaidem 244, 245
Stejar T74MRAstm+RAMonteluk21.5121spiro157.8
Stejar T78MUAB+RAMonteluk21.5121spiro/poz polen175.8CONTROLAT AB, pt RA - Mometaz/nasO seridem 226Dermat
Stoica R4MUWR7
Stoican ACMRWR+RA19110
Stoicescu T31MUWR+RAMonteluk17106>>CONTROLATDermatita
Suta DC8MUTC+RADeslor9M dermatita, surori cu WR,
Szilagy A14MUWR+RAMonteluk11.4RA severaDermat
Szilagy DO44MUWR+RA94O ser6%IgA si G usor39.5C[367 PACIENTI FEBRILI esantion IAN - NOV 2012]
PACIENTI NETERMOMETRIZATI[141 PAC din 1753 Prezentati - esantion Ian - Nov 2012]
Febra inalta este frecventa?
Chart5
34
333
FEBRA >39.5C[367 PACIENTI FEBRILI esantion IAN - NOV 2012]
Sheet1
numevarstasexdomicdgtratGTteste cutanateIgER AdverseComplicatiiEozinofileAHCObs
Anastasiu M39MUTC+RA12.593
Anastasiu M41MUTC+RA12.593poz pt par caineidem 2
Ancu IEFRTC+RA17113
Andronie SG133MUAB+RAFlt/inh36141Pectus escav
Anghel DI36MRWR1394
Anghel IT83MUWR+RA25.5124.5spirofrate WR
Anghel M17MUWR+RAMonteluk9.2frate WRDermatita
Anghel V72MUWR+RA241233890/7103
Angheluta GM66FRWR17.5113
Apostol MA33FUWR1390Spasmul hohot plans
Apostol MA37FUWRMonteluk13.592Spasmul hohot plansidem 11
Ardelean A31FUWRfrate WR
Ardelean I66MUWR+RAsora WR
Asmarandei T14MUWR96
Asmarandei T15MUWR indV96idem 89
Badea A72FUWR18.5116mama astm trat cu ICS+LABAUrticarie
Badea AL60MUWR+RAMonteluk+Mometaz/nas19119spiro
Badea AL66MUWR+RAMonteluk+Mometaz/nas20121spiroCONTROLATOSA
Badea AL64MUAB+RAMonteluk+Flixo/inh+Mometaz/nas20121spiroCONTROLATOSA
Badita TN79MUWR21119687
Balanica T106MRAB27.5133
Banca V31MRTC+wheezing14.595.5
Banica AA59MRWR+RAMonteluk+Flt/nas16.8110spiro/poz acarieni3000EVOL FAVORRA severa
Barsan MI52FUWR+RAMonteluk+Flt/inh HD18104spiroRA severaidem 38Dermat4 exac in 10 luni
Barsan MI53FUWR+RAMonteluk+Flt/inh HD18104spiroidem 17Dermat
Barsan MI54FUWR+RAMonteluk+Flt/inh HD19106spiroRA severaidem 7 - 8dermat
Barsan MI55FUWR+RAMonteluk+Flt/inh19106spiroCONTROLAT - se scade doza Flt/inhRA severaidem 22. 23. 24Dermatita
Barsan MI56FUWR+RAMonteluk+Flt/inh18106spiroCONTROLATRA severaidem 23-26Dermatita
Bicher SM46MUWR+RA17.5
Botea S32MUWRnegNDermatita
Botez LA17MUWRBDP - ventilat mecanic 10 z
Brezeanu TG53MUTC+RA22115spiroNTRAHEOMALACIE1 exacerb in 5 luni
Brezeanu TG56MUTC+RA23116spiroTRAHEOMALACIEidem 28
Brezeanu TG59MUTC+RA22118CONTROLATTRAHEOMALACIEidem 31, 32
Buhnia T106MUABspiro
Buican R9MUWR+RA291%Dermat++
Buican R12MUWR+RAMonteluk291%idem 34Dermat++
Bulai L27MUWR14.593NN
Cadar R63MUWR+RA21.5116232.5O serM AB, T RA+urticarii
Calin MA71FUWR42127.5spirofrate cu RAObezitate
Calman MD63MUAB+RA26.5119.5spiro/poz acarieni+mucegaiRA severa
Cantoneru L50MUWR+RA16106
Caracuda C60FUTC+RA21.3116spiroRA severa
Ceausu IA61FUWR26118spiro10.75.6%[400]SUPRAPOND
Cernica TD56FURA18116
Chebarus AD23MUWR+RAMontelukpoz cazeinaIPLVDermat
Chebarus AD25MUWR+RAMontelukpoz cazeina42.2IPLVidem 43
Chirita S67FRAstm+RA20119.2spiro / pozNev Ota
Cioroianu EB56MUTC+RAMonteluk+Momet/nas20115spiroEVOL BUNA DE 6L
Cioroianu EB58MUWR+RAMonteluk+Mometaz/nas20115spiroNECONTROLAT - TC=WR>3/an[scor CR+]T AB M fumatidem 43
Citea M90MRTC+RAMonteluk23.5124spiro72M fumatoare
Ciucur R134MUAstm+RA
Codrea DM68MUTC+RARA severa
Cojocaru AL124MUWR+RAMonteluk47150spiro/poz acarieni>>RA severa
Coman AR66MRAB+RAMonteluk+Mometaz/nas32.5123spiro
Coman AR70MRAB+RAMonteluk+Xyzal36125spiroCONTROLATSUPRAPONDidem 48Dermat++
Constantin RCMUWR+RA26123
Constantin TA35MUWR+RAMonteluk+Mometaz/naspoz albus ou26.85%
Constantinescu S92FUAstm+RA22.512866511.4% [680]
Constantinescu S95FUAB+RAFlt/inh+Flt/nas23.5130spiroCONTROLATidem 48
Corcodel D40MUAB+RATC - N VienaNO serRA severa
Coricica AM23MUWRMonteluk10.882T SUDORII - 3413.70%repetate scaune cu sange
Cosma IA35FUWR+RAMontelukO ser
Costache MC47FUWr+TC
Costache T48MUWR+RA22122
Costan M36MURA18.5102O serDermat
Craiciu RM19MUWR indVMonteluk12.21 episod BO "dramatic"
Croitoru A27MUWR+RAMonteluk13101.7RA severa
Dane A68MUWR17.5110
Dasu M84MU4327.50%
Dinca BA158MUABICS+LABA [Seretide discus]59167spiroCONTROLAT
Dinu EA48MUWRMonteluk15105strabunica astm, matusa mat alergie polen
Dinu LC43FUTC+RA20.5107RGE
Dirla AO72MUAB+RAFlt/inhspirodepresie monteluk
Dirla AO75MUWR[exacerb]+RAFlt/inh+SABA+Deslor+Mometaz/nasspiroDepresie majora Montelukidem 51
Dirla AO75MUWR[exacerb]+RAFlt/inh+SABA+Deslor+Mometaz/nasspiroDepresie Majora Montelukidem 51 si 208
Dirla AO77MUAB+RAFlt/inh+Deslor+Mometaz/nasCONTROLATDepresie majora Montelukidem 68, 69, 70
Dobre CL55MUWR+RAMonteluk+Momet/nas14.7100.512115%RA severa
Dobrila V67MUAstm+RA24118RA severa
Dobrila V68MUAB+RAMonteluk+antihistTS 34; ECO C nRA severaidem 21
Dobrila V70MUWR+RAMonteluk+Mometaz/nas24118CONTROLATM RARA severaidem 53, 54
Dogaru CA52MUAB+RA22116poz polenuri
Donose MA51MUTC+RA17.2107.576.3VDC
Draghia AC148FRTC+RA56160spiroDermatita
Dragotoniu AE36FRWR+RAMonteluk1497.510.80%Tata & Mama RARA severaDermat
Dragotoniu AE42FRWR+RAMonteluk14.599CONTROLAT10.80%T si M RARA severaidem 78
Dumitrescu AMUWR+RA24.3120spirovar cu WRADHD?
Dumitrescu A73MUWR+RAMonteluk+Mometaz/nasspiroCONTROLAT
Dumitrescu S37MUAB+RA14.5Dermatita
Dumitriu V50MUWR+RAspiroDermat
Dumitru FC111MUAstm41138.5spiro
Duta RN62MUWR+RAMonteluk+Mometaz/nas+Ketof20114spiro>>10.90%RA severaDermatita
Duta RN66MUWR+RAMonteluk?Mometaz/nas+Ketof20.5116spiro>>CONTROLAT10.90%RA severaidem 84Dermatita ++
Enache DC47MRAstm [Ex]Mometa+Deslor+Monteluk17spiro
Filipoiu AM13FUTC10.9sora WRMACROSOM
Florea C171FUTC58.5151Obezitate
Florea V75MUAstm [Ex]+RA29128
Furdui TA48MUWR/exacerb usoaraMontelukspiro
Geambazzi AA20MRWR [Ex]MontelukPectus escav
Geambazzi AA22MRWR/exacerb usoaraMontelukEVOL >3epis WR/ansora cu WRidem 25Pectus escav
Geambazzi SP47FRWR [Ex]Monteluk
Geambazzi SP51FRWRCONTROLATidem 83
Georgescu AI61FUWR+RAMonteluk20.5115.8spirofrate WR
Georgescu MA66MRWR+RA20.5121poz mucegai18.3Polipi corzi vocale
Georgescu RA72MUWR+RAMonteluk+Flt/nasO ser
Gherghelescu I14FUWRMonteluk
Ghidrigan SC104MUAstm [Ex]+RA29.5132.5374Depresie Majora5%
Ghidrigan SC107MUAstm+RALABA+ICS29.5133spiroDepresie Majora5%
Ghincea MA136FUABspiroVCD, OBEZ
Gorgan M31FUTC+RA22
Gramescu A60FUTC20.5113.5TRAHEOMALACIE
Grecu A42FUTC+RA16.51026.2%[510]
Grigoras C67FUWR IACRS23NEFRECTOMIE PARTIALA
Grigoras C69FUWR23idem 64
Grigorgore M26FUWRDermatita
Grozavu D76MRTC+RA20115
Guzu A29MUWR+RAMontelukRA severa
Guzu A30MUWR+RAMonteluk+Flt/nasEVOL FAVOR RARA severaIDEM 58
Guzu A32MUWR+RAMonteluk+Flt/nasCONTROLATRA severaidem 75,76
Himpa T103MUAB+RAMonteluk+Mometaz/nas40138.5spiroCONTROLATRA severa
Hornoiu B27MUWR+RAMonteluk11.593
Hornoiu B31MUWR+RAMonteluk1496CONTROLATidem 97
Iacob-Ritzi A18MUWR+RAFlt/inh11.2Pectus escav
Iancu MA98FUTC+RA34139spiroHipertrofie adenoamigdaliana - operatie
Iancu MA100FUTC+RA36141spiroPubertate precoceidem 69
Ichim EG78FRTC
Ilia RV102MUWRFlt/inh32136.5
Ilia RV103MUWRFlt/inh33136.5idem 35
Ilia RV104MUWRFlt/inhEVOL FAVOR
Ilia RV105MUWRFlt/inh HDspiro
Ilie CN125MUAstm+RAMonteluk+DeslorRA severa dupa oprirea medic)idem 70
Ilie CN126MUAstm+RAMonteluk+Deslor38142spiroidem 19
Incicas A52FUAstm+RA18.5111poz mucegai>>Dermat
Ion R72FUWR+RApoz polenuri+mucegai
Ion RE20FUWRM AB
Ionescu LA27MUTC13
Ionica M54FUWR
Iordache R7MUWR767Traheomalacie
Iordachi S27MUWR[Ex]
Iordan AA56MUWR+RAMonteluk15106spiro60.2Dermat
Jurubita AA31FUWR+RAMonteluk+Flt/inh13.598IPLVDermat
Jurubita AA32FUWR+RAMonteluk+Flt/inh+Mometaz/nas13.598IPLVidem 189Dermat
Jurubita AA34FUWR+RAMonteluk+Flt/inh+Mometaz/nas14100poz cazeinaIPLVidem 115, 116Dermat
Karali A32FUTC11.590Dermat
Lacraru RP53MUAB+RAMonteluk+ketotif18.5113spiroEVOL FAVORDermat
Lambrea DMUWR35141spirovar cu WR
Lazar AL26MUWR16MACROSOM
Leanca DC10MRWRRGE
Leonte DFUAstmspirobunic decedat astm
Licu MI50MUWR15108Pectus escavidem 53
Licu MI51MUWR [Ex]15.5108Pectus escavidem 31
Licu MI52MUWR15.5108idem 31
Luca AL108FUTC40.5130VCD, SUPRAPOND
Luca AL109FUTC40.5130VCD, SUPRAPONDidem 134
Maftei MP119MUAstm+RAFlt/inh+Mometaz/nas36143Dermatita
Maftei MP120MUAB+RAFlt/inh+Mometaz/nas36143idem 89Dermatita
Maftei MP125MUAB+RAMontelukspiroCONTROLAT - se scoate doza Flt/inh
Mainov IM66MUWR+RAMonteluk+Flt/nas35.6120spiroNfrate RA+unchi WRHipertrofie adenoamigdalianaDermat
Mainov IM68MUWR+RAMonteluk+Flt/nas+Flt/inh29121spiroCONTROL MEDIOCRU - adaugat ICSO serfrate WR+ unchi WRRA severaidem 105
Mainov MI71MUAB+RAMonteluk+Flt/inh29120spiroCONTROLATfrateWR/RA+unchi WROBEZ, OASidem 147
Mainov SG40MUWR+RAMonteluk16.5102frateRA+unchi WRPectus escavatum
Mainov SG42MUWR+RAMonteluk16.2103frate WR+ unchi WRPectus escavatumidem 106
Mainov SG44MUWR+RAMonteluk16.5104CONTROLATfrateAB/RA+unchi WRPectus escavatumidem 148-149
Marin DC69MRAB+RAMonteluk18.5109spiroCONTROLATPectus escavatum
Marin EF37FUWR+RAMonteluk1599128NECONTROLAT - ADAUGAT Flt/inh+Deslor+Mometaz/nasRA severa
Marin EF38FUAB+RA1599.5spiroRA severaidem 46
Marin EF40FUAB+RAMonteluk+Flt/inh+Deslor+Mometaz/nas15.6101RA severaidem 109
Marin MA10FRWRMonteluk8.57725M RA, matusa WR
Marinescu AM35FUWR+RAMontelukCONTROLAT PARTIAL - se introd Monetaz/nas
Marin-Gogan M51MURA
Matache M21MRWRMonteluk
Matei A51MUWR+RA625.6%[493]T WR+RABDP
McCollum M87MUAB+RAFlt+Saim/inh+Mometaz/nas+Monteluk26.5132spiroEVOL FAVOR DUPA EXACERB SEVERARA severaDematita
McCollum M88MUAB+RAFlt+Saim/inh+Mometaz/nas+Monteluk26.5132spiroRA severaDematita
McCollum M88MUAB+RAFlt+Saim/inh+Mometaz/nas+Monteluk26132RA severaidem 112 si 113Dematita
Meita D101MUABFlt/inh HD29134spiro/paneluri+>>T dermat M RA
Meita D101MUABFlt/inh HD29134spiro>>EVOL FAVORT dermat M RAidem 95
Meita D103MUAB[exacerb]+RA29134spiroidem 153, 154
Mereuta R168MUAB+RA50.4164spiro/ +polen
Mereuta R168MUAB+RA50164spiroidem 86
Mihai T72MUWR+RAMonteluk20116Hipertrofie adenoamigdaliana - coblatie
Mihai T73MUWR+RAidem 98
Mirea AM150MUTC+RA56154spiroTRAHEOMALACIE, Emotiv, depresiv; teratom operat
Mirea AM151MUTC+RA56154spiroTRAHEOMALACIE, Emotiv, depresiv; teratom operatidem 218
Mirea AM152MUTC+RA56154spiroCONTROLATTRAHEOMALACIE, Emotiv, depresiv; teratom operatidem 148, 149
Mirea RMUWR
Mocanita VM60MUTC+RA
Munteanu M204FUAB+RAspiro/poz par pisicaDermatita
Munteanu M206FUAB+RAspiro/poz par pisicaidem 162Dermat
Murata A81MUWR+RAspiro
Naftan DG54MUWR+RAMonteluk+Deslor6594%T RARA severa
Naghy N69FUAB+RAFlt/inh+Mometaz/nas19.5118spiroM RARA severa2 exacerb in 5 luni
Naghy N69FUAB[exacerb]+RAFlt/inh+Mometaz/nas19.5118spiroRA severaidem 175
Naghy N70FUAB+RAFlt/inh+Mometaz/nas+Deslor20118spiroM RARA severaidem 175. 178
Naghy N71FUAB+RAMonteluk+Flt/inh+Mometaz/nas+Deslor21119spiroCONTROLATM RARA severaidem 123,124, 125
Naghy N71FUAB+RAMonteluk+Flt/inh+Mometaz/nas20119spiroCONTROLATM RARA severaidem 165-168
Neacsu P17MUTCPneumonii recurente - deficit imuniv A+G select
Neagu AF63MUWR+RA1919Pectus escavatum
Nica TA25MUWR+RAMonteluk17.2EVOL FAVORDermatita ++
Niculae AM42MUWR+RA16.5101RA severa
Niculae AM43MUWR+RAMonteluk16r adv FLTinhEVOL FAVORO CRIZA SEVERAidem 103
Niculeasa MT54FUTC+RA17
Nita-Manu MA48MUWRFlt/inh EPISODICEVOL >3epis WR/an
Novac TMUAB19.5117.8Limfom Hodgkin
Obiziuc A44MUWR+RAFlt/nas21.5112idm 57
Obiziuc A45MUWR+RAFlt/nas21.5112idem 4
Ocheana DA62MRRA17.5113poz pt acarieni2864.20%
Oprea AM55FRTC+RA21.5116spiro
Oprea EA133FRAB+RAMonteluk58144spiroCONTROLATOBEZITATE
Palos VD24MUWR
Pandaru-Rugina D15MURC10.7frate WRStridor laring cong
Pandaru-Rugina MA38MUWR+RAMonteluk16102.5spiro
Pandaru-Rugina MA40MUWR+RAMonteluk16103spiro
Pantile TC83MRWR+RAMonteluk+Flt/inh+Mometaz/nas20119spiroO ser
Pantile TC89MRAB+RAMonteluk+Flt/inh+Monetaz/nas21.5121spiroCONTROLATidem 141
Parascu A48MRWR+RA26119.5spiro284RA severa
Pascu MV99MUWR+RA37140spiro3.5%[232]T WR M WR+Dermatita
Patrascanu FR42MUTC+RAMometa+Deslor151016.2N
Paun Z30FUWR/exacerb usoarasora cu atopieDermatitaINTERNATA
Paunescu T42MUWR+RAT RA severa, M RA+urticarieDermat
Pedrazzini34MRWR+RAFlt/inh+DeslorAgit MontelukO seridem 74
Pedrazzini35MRWR+RAFlt/inh+DeslorRA severaidem 14
Petrescu DA93MUWR+RA21.5125poz acarieni780/234015%
Petrescu J36FUAstm+RAMonteluk+Flt/inh
Picu AE60FUWR16.5104.5ADHD
Pirjolescu FS64FUTC+RAMonteluk+Mometaz/nas25118CONTROLAT
Platteeuw L163MUABFlt/inh63.5180spiroConvalescent Pneumonie cu r pleurala si HRB
Polifrone SM85MUWR+RA24123.7spiro>>
Pop AF74MUWRMonteluk36131OBEZ, hiperemotiv, sechele PC
Popa M54FRWR+RA16104
Popescu A122FRWR+RAMontelukspiro
Popescu AMG88FUAB+RAFlt/inh HD+Monteluk18118spiro/ poz mucegai1256/1788RA severaastm sever
Popescu AMG90FUAB+RAFlt/inh HD+Monteluk18118spiro/poz mucegai1256CONTROLATRA severaidem 189Astm sever
Popescu EM41FUWRMonteluk13.898
Popescu R53MUTC+RA18.5105
Popescu S97MUAB+RA25125spiro808
Popescu VA105MUTC+RAMonteluk+Mometaz/nas+D330130.5232HipoCa
Posea R34MUWR+RAMonteluk+Mometaz/nas14100478Dermat
Posea R35MUWR+RAMonteluk+Mometaz/nas14101478idem 221Dermatita
Puiu CLMUWR+RA23.5119
Radu AAMUAstm+RAspiro
Radu AV158MUTC50155spirofrate TC si EIB
Radu MS37MUWR indVSUPRAPOND
Radu SA121MUTC+RA40139spiro/poz polen238frate TC si EIB
Radulescu MIFUAB+RALoratadina30134spiro25.82.48%mama RA
Radulescu MIFUABMontelukspiroidem 111
Rangu AG41FWR+RA
Rizea DC82MRTC+RA27.7128
Roman E28MUTC13
Sandulescu T85MUWR+RAMonteluk22.2120spiro84CONTROLATDermatita
Sebes LV44MUWR+RA15.5101.5IPLVDermat
Secula TI75MUWR22.3119.5bunica astmDermatita
Setareh SFUTC+RA21.5116RA severaDermat
Simion M57MUAstm+RAMonteluk+Flt/inh+Deslor16375RA severa
Sisu VC48MUWR+RA711RGEDermat
Sisu VC49MUWR+RAMonteluk17105711RA severa
Sitaru ARMRWRpoz par hamster280
Sitaru EDFRWR+RAfrate WR, sensibilizat par hamsterDermat
Sofron D90FRTC+RAMometaz/nas27128spiro6.2VCD
Stan MG41MUWR+RA14.597alergie medic - beta-lactami
Stancescu DG79MRAB20119poz pt acarieni
Stanciu A43FRWR+RA15O ser
Stancu MT94FUAB[exacerb]+RAFlt/inh HD + SABA30138spiro/poz par pisica, calNECONTROLAT - dat ICS+LABA [Symbicort]Dermat++
Stancu MT95FUAB+RASymbicort [ICS+LABA}30138spiro/poz par pisica, calCONTROLAT - scos Symbicort - ICS HD+Montelukidem 243Dermat++
Stanga AM43MUWR+RAMonteluk161025.60%Bunica RARA severa
Stanga AM46MUWR+RAMonteluk+Mometaz/nas+Deslor16104EVOL FAVOR5.60%Bunica RARA severaidem 139
Stanga AM49MUWR+RaMonteluk+Mometaz/nas17107CONTROLAT5.60%Bunica RARA severaidem 244, 245
Stejar T74MRAstm+RAMonteluk21.5121spiro157.8
Stejar T78MUAB+RAMonteluk21.5121spiro/poz polen175.8CONTROLAT AB, pt RA - Mometaz/nasO seridem 226Dermat
Stoica R4MUWR7
Stoican ACMRWR+RA19110
Stoicescu T31MUWR+RAMonteluk17106>>CONTROLATDermatita
Suta DC8MUTC+RADeslor9M dermatita, surori cu WR,
Szilagy A14MUWR+RAMonteluk11.4RA severaDermat
Szilagy DO44MUWR+RA94O ser6%IgA si G usor39.5C[367 PACIENTI FEBRILI esantion IAN - NOV 2012]
Mecanismele FebreiFebra in sine nu este o boala!
Febra este un mecanism fiziologic pentru combaterea diverselor infectii.Incetineste replicarea virala sau bacterianaAccelereaza productia de PMN si limfocite TAccelereaza traficul de celule cu rol imun
Modalitati de evaluare copilmasurare rectala & orala
Modalitati de evaluare scolarmasurare axilara & orala
Erori de masurare tehnice 1
Erori de masurare tehnice 2
FEBRA IN PATOLOGIA PEDIATRICAPLANUL LUCRARIIINTRODUCEREBOLI FEBRILE LA COPILTRATAMENT ANTITERMICEFECTE ADVERSECONCLUZII
BOLI CU FEBRA LA COPIL
BOLI CU FEBRA LA COPILStudiu pe un lot de 10.000 copii evaluati de MF*Infectiile sunt cauza frecventa de prezentare la medic.dar nu singura cauza de febra!!Pe grupe de varsta sunt infectii la:60% la 0-1 an( cu cat e mai mic daca are febra.poate fi infectie)!!36% la 1-4 ani20% la 5-15 ani
BOLI CU FEBRA LA COPILNu numai infectiile pot genera febra!Inflamatii acuteBoli reumatismale [ACJ, RAA, LES, PAN, Sindrom Kawasaki, etc]Inflamatie alergicaIntoxicatii acute [accidentale, iatrogene]Anomalii termoreglare [tumori diencefalice]Febra factitiala / sindr Munchausen( INDUS DE CINEVA,minciuni)
BOLI CU FEBRA LA COPILSemne de gravitate
BOLI CU FEBRA LA COPIL
Boli febrile cu potential de severitate >>SepticemieMeningitaPielonefritaPneumonie acuta
Care este ponderea cauzelor de febra?Cea mai frecventa cauza de febra fara focar la copilul prescolar sunt bolile virale
Bolile de colagen reprezinta 9%Malignitatile reprezinta 6% Copii cu febra fara origine!!1 din 7 dn cei cu febra fara focar poate avea o boala grava!!!
Dar la sugar ?Nici la sugarul cu varsta sub 3 luni, care are doar febra izolata nu exista un risc semnificativ de boala bacteriana.
2.1% din 1112 sugari cu varsta
Criteriile Rochester pentru severitate redusa in infectii cu febra la sugar
FEBRA IN PATOLOGIA PEDIATRICACriterii clinice de mare severitate febra ce asociaza eruptie (meningococemie)Febra ce asociaza coma sau convulsii (meningoencefalita)
FEBRA IN PATOLOGIA PEDIATRICAPLANUL LUCRARIIINTRODUCEREBOLI FEBRILE LA COPILTRATAMENT ANTITERMICEFECTE ADVERSECONCLUZII
TRATAMENT FEBRA
Este foarte diferita perspectiva asupra tratamenului febrei la :copil parinte medic
Perspectiva pacientului COPILUL SCOLARFebra legitimeaza statutul de pacient / pacient
Febra produce empatie / ingrijorare / toleranta
Febra aduce BENEFICIISunt bolnav nu mai merg la scoala Nu mai fac lectii Pot sa stau acasa si sa ma joc
Perspectiva parintelui - 1Febra produce ingrijorare *
CAUZA NR 1 de ingrijorare parentala
Motiv frecvent de medicatie fara prescriptie sau consult medical
*Kay J What worries parents when their preschool children are acutely ill and why? : a qualitative study. BMJ 1996;313:983-6.
Perspectiva parintelui - 2Febra este expresia unei situatii GRAVE
Febra produce PANICA*
Termenul fever phobia - 1980
*Schmitt BD Fever phobia. Am J Dis Child 1980;134:176-81.
Fever phobia la halatele albe *230 medici de CPU intervievati in SUA. temperatura considerata a fi febra 37.8C Temperatura medie considerata ca fiind nociva 40.6C [limite 37.8 - 43.3C]. Temperatura medie la care s-au inceput antipireticele 37.8C Peste 1/3 din medici au recunoscut ca au administrat antipireticele inadecvat [exces de zel]. * Poirier MP, Collins EP, McGuire E Fever phobia: a survey of caregivers of children seen in a pediatric emergency department. Clin Pediatr (Phila). 2010;49:530-4.
Perspectiva medicului 2
Alte date din practica
In UK medicii de familie folosesc rareori termomentrul *Deseori tehnica de termomentrizare este incorecta
* Clarke S The use of thermometers in general practice. Br Med J 1992;304:961-3.
In Romania realitati despre termometrizare
Chart1
141
1612
PACIENTI NETERMOMETRIZATI[141 PAC din 1753 Prezentati - esantion Ian - Nov 2012]
Sheet1
numevarstasexdomicdgtratGTteste cutanateIgER AdverseComplicatiiEozinofileAHCObs
Anastasiu M39MUTC+RA12.593
Anastasiu M41MUTC+RA12.593poz pt par caineidem 2
Ancu IEFRTC+RA17113
Andronie SG133MUAB+RAFlt/inh36141Pectus escav
Anghel DI36MRWR1394
Anghel IT83MUWR+RA25.5124.5spirofrate WR
Anghel M17MUWR+RAMonteluk9.2frate WRDermatita
Anghel V72MUWR+RA241233890/7103
Angheluta GM66FRWR17.5113
Apostol MA33FUWR1390Spasmul hohot plans
Apostol MA37FUWRMonteluk13.592Spasmul hohot plansidem 11
Ardelean A31FUWRfrate WR
Ardelean I66MUWR+RAsora WR
Asmarandei T14MUWR96
Asmarandei T15MUWR indV96idem 89
Badea A72FUWR18.5116mama astm trat cu ICS+LABAUrticarie
Badea AL60MUWR+RAMonteluk+Mometaz/nas19119spiro
Badea AL66MUWR+RAMonteluk+Mometaz/nas20121spiroCONTROLATOSA
Badea AL64MUAB+RAMonteluk+Flixo/inh+Mometaz/nas20121spiroCONTROLATOSA
Badita TN79MUWR21119687
Balanica T106MRAB27.5133
Banca V31MRTC+wheezing14.595.5
Banica AA59MRWR+RAMonteluk+Flt/nas16.8110spiro/poz acarieni3000EVOL FAVORRA severa
Barsan MI52FUWR+RAMonteluk+Flt/inh HD18104spiroRA severaidem 38Dermat4 exac in 10 luni
Barsan MI53FUWR+RAMonteluk+Flt/inh HD18104spiroidem 17Dermat
Barsan MI54FUWR+RAMonteluk+Flt/inh HD19106spiroRA severaidem 7 - 8dermat
Barsan MI55FUWR+RAMonteluk+Flt/inh19106spiroCONTROLAT - se scade doza Flt/inhRA severaidem 22. 23. 24Dermatita
Barsan MI56FUWR+RAMonteluk+Flt/inh18106spiroCONTROLATRA severaidem 23-26Dermatita
Bicher SM46MUWR+RA17.5
Botea S32MUWRnegNDermatita
Botez LA17MUWRBDP - ventilat mecanic 10 z
Brezeanu TG53MUTC+RA22115spiroNTRAHEOMALACIE1 exacerb in 5 luni
Brezeanu TG56MUTC+RA23116spiroTRAHEOMALACIEidem 28
Brezeanu TG59MUTC+RA22118CONTROLATTRAHEOMALACIEidem 31, 32
Buhnia T106MUABspiro
Buican R9MUWR+RA291%Dermat++
Buican R12MUWR+RAMonteluk291%idem 34Dermat++
Bulai L27MUWR14.593NN
Cadar R63MUWR+RA21.5116232.5O serM AB, T RA+urticarii
Calin MA71FUWR42127.5spirofrate cu RAObezitate
Calman MD63MUAB+RA26.5119.5spiro/poz acarieni+mucegaiRA severa
Cantoneru L50MUWR+RA16106
Caracuda C60FUTC+RA21.3116spiroRA severa
Ceausu IA61FUWR26118spiro10.75.6%[400]SUPRAPOND
Cernica TD56FURA18116
Chebarus AD23MUWR+RAMontelukpoz cazeinaIPLVDermat
Chebarus AD25MUWR+RAMontelukpoz cazeina42.2IPLVidem 43
Chirita S67FRAstm+RA20119.2spiro / pozNev Ota
Cioroianu EB56MUTC+RAMonteluk+Momet/nas20115spiroEVOL BUNA DE 6L
Cioroianu EB58MUWR+RAMonteluk+Mometaz/nas20115spiroNECONTROLAT - TC=WR>3/an[scor CR+]T AB M fumatidem 43
Citea M90MRTC+RAMonteluk23.5124spiro72M fumatoare
Ciucur R134MUAstm+RA
Codrea DM68MUTC+RARA severa
Cojocaru AL124MUWR+RAMonteluk47150spiro/poz acarieni>>RA severa
Coman AR66MRAB+RAMonteluk+Mometaz/nas32.5123spiro
Coman AR70MRAB+RAMonteluk+Xyzal36125spiroCONTROLATSUPRAPONDidem 48Dermat++
Constantin RCMUWR+RA26123
Constantin TA35MUWR+RAMonteluk+Mometaz/naspoz albus ou26.85%
Constantinescu S92FUAstm+RA22.512866511.4% [680]
Constantinescu S95FUAB+RAFlt/inh+Flt/nas23.5130spiroCONTROLATidem 48
Corcodel D40MUAB+RATC - N VienaNO serRA severa
Coricica AM23MUWRMonteluk10.882T SUDORII - 3413.70%repetate scaune cu sange
Cosma IA35FUWR+RAMontelukO ser
Costache MC47FUWr+TC
Costache T48MUWR+RA22122
Costan M36MURA18.5102O serDermat
Craiciu RM19MUWR indVMonteluk12.21 episod BO "dramatic"
Croitoru A27MUWR+RAMonteluk13101.7RA severa
Dane A68MUWR17.5110
Dasu M84MU4327.50%
Dinca BA158MUABICS+LABA [Seretide discus]59167spiroCONTROLAT
Dinu EA48MUWRMonteluk15105strabunica astm, matusa mat alergie polen
Dinu LC43FUTC+RA20.5107RGE
Dirla AO72MUAB+RAFlt/inhspirodepresie monteluk
Dirla AO75MUWR[exacerb]+RAFlt/inh+SABA+Deslor+Mometaz/nasspiroDepresie majora Montelukidem 51
Dirla AO75MUWR[exacerb]+RAFlt/inh+SABA+Deslor+Mometaz/nasspiroDepresie Majora Montelukidem 51 si 208
Dirla AO77MUAB+RAFlt/inh+Deslor+Mometaz/nasCONTROLATDepresie majora Montelukidem 68, 69, 70
Dobre CL55MUWR+RAMonteluk+Momet/nas14.7100.512115%RA severa
Dobrila V67MUAstm+RA24118RA severa
Dobrila V68MUAB+RAMonteluk+antihistTS 34; ECO C nRA severaidem 21
Dobrila V70MUWR+RAMonteluk+Mometaz/nas24118CONTROLATM RARA severaidem 53, 54
Dogaru CA52MUAB+RA22116poz polenuri
Donose MA51MUTC+RA17.2107.576.3VDC
Draghia AC148FRTC+RA56160spiroDermatita
Dragotoniu AE36FRWR+RAMonteluk1497.510.80%Tata & Mama RARA severaDermat
Dragotoniu AE42FRWR+RAMonteluk14.599CONTROLAT10.80%T si M RARA severaidem 78
Dumitrescu AMUWR+RA24.3120spirovar cu WRADHD?
Dumitrescu A73MUWR+RAMonteluk+Mometaz/nasspiroCONTROLAT
Dumitrescu S37MUAB+RA14.5Dermatita
Dumitriu V50MUWR+RAspiroDermat
Dumitru FC111MUAstm41138.5spiro
Duta RN62MUWR+RAMonteluk+Mometaz/nas+Ketof20114spiro>>10.90%RA severaDermatita
Duta RN66MUWR+RAMonteluk?Mometaz/nas+Ketof20.5116spiro>>CONTROLAT10.90%RA severaidem 84Dermatita ++
Enache DC47MRAstm [Ex]Mometa+Deslor+Monteluk17spiro
Filipoiu AM13FUTC10.9sora WRMACROSOM
Florea C171FUTC58.5151Obezitate
Florea V75MUAstm [Ex]+RA29128
Furdui TA48MUWR/exacerb usoaraMontelukspiro
Geambazzi AA20MRWR [Ex]MontelukPectus escav
Geambazzi AA22MRWR/exacerb usoaraMontelukEVOL >3epis WR/ansora cu WRidem 25Pectus escav
Geambazzi SP47FRWR [Ex]Monteluk
Geambazzi SP51FRWRCONTROLATidem 83
Georgescu AI61FUWR+RAMonteluk20.5115.8spirofrate WR
Georgescu MA66MRWR+RA20.5121poz mucegai18.3Polipi corzi vocale
Georgescu RA72MUWR+RAMonteluk+Flt/nasO ser
Gherghelescu I14FUWRMonteluk
Ghidrigan SC104MUAstm [Ex]+RA29.5132.5374Depresie Majora5%
Ghidrigan SC107MUAstm+RALABA+ICS29.5133spiroDepresie Majora5%
Ghincea MA136FUABspiroVCD, OBEZ
Gorgan M31FUTC+RA22
Gramescu A60FUTC20.5113.5TRAHEOMALACIE
Grecu A42FUTC+RA16.51026.2%[510]
Grigoras C67FUWR IACRS23NEFRECTOMIE PARTIALA
Grigoras C69FUWR23idem 64
Grigorgore M26FUWRDermatita
Grozavu D76MRTC+RA20115
Guzu A29MUWR+RAMontelukRA severa
Guzu A30MUWR+RAMonteluk+Flt/nasEVOL FAVOR RARA severaIDEM 58
Guzu A32MUWR+RAMonteluk+Flt/nasCONTROLATRA severaidem 75,76
Himpa T103MUAB+RAMonteluk+Mometaz/nas40138.5spiroCONTROLATRA severa
Hornoiu B27MUWR+RAMonteluk11.593
Hornoiu B31MUWR+RAMonteluk1496CONTROLATidem 97
Iacob-Ritzi A18MUWR+RAFlt/inh11.2Pectus escav
Iancu MA98FUTC+RA34139spiroHipertrofie adenoamigdaliana - operatie
Iancu MA100FUTC+RA36141spiroPubertate precoceidem 69
Ichim EG78FRTC
Ilia RV102MUWRFlt/inh32136.5
Ilia RV103MUWRFlt/inh33136.5idem 35
Ilia RV104MUWRFlt/inhEVOL FAVOR
Ilia RV105MUWRFlt/inh HDspiro
Ilie CN125MUAstm+RAMonteluk+DeslorRA severa dupa oprirea medic)idem 70
Ilie CN126MUAstm+RAMonteluk+Deslor38142spiroidem 19
Incicas A52FUAstm+RA18.5111poz mucegai>>Dermat
Ion R72FUWR+RApoz polenuri+mucegai
Ion RE20FUWRM AB
Ionescu LA27MUTC13
Ionica M54FUWR
Iordache R7MUWR767Traheomalacie
Iordachi S27MUWR[Ex]
Iordan AA56MUWR+RAMonteluk15106spiro60.2Dermat
Jurubita AA31FUWR+RAMonteluk+Flt/inh13.598IPLVDermat
Jurubita AA32FUWR+RAMonteluk+Flt/inh+Mometaz/nas13.598IPLVidem 189Dermat
Jurubita AA34FUWR+RAMonteluk+Flt/inh+Mometaz/nas14100poz cazeinaIPLVidem 115, 116Dermat
Karali A32FUTC11.590Dermat
Lacraru RP53MUAB+RAMonteluk+ketotif18.5113spiroEVOL FAVORDermat
Lambrea DMUWR35141spirovar cu WR
Lazar AL26MUWR16MACROSOM
Leanca DC10MRWRRGE
Leonte DFUAstmspirobunic decedat astm
Licu MI50MUWR15108Pectus escavidem 53
Licu MI51MUWR [Ex]15.5108Pectus escavidem 31
Licu MI52MUWR15.5108idem 31
Luca AL108FUTC40.5130VCD, SUPRAPOND
Luca AL109FUTC40.5130VCD, SUPRAPONDidem 134
Maftei MP119MUAstm+RAFlt/inh+Mometaz/nas36143Dermatita
Maftei MP120MUAB+RAFlt/inh+Mometaz/nas36143idem 89Dermatita
Maftei MP125MUAB+RAMontelukspiroCONTROLAT - se scoate doza Flt/inh
Mainov IM66MUWR+RAMonteluk+Flt/nas35.6120spiroNfrate RA+unchi WRHipertrofie adenoamigdalianaDermat
Mainov IM68MUWR+RAMonteluk+Flt/nas+Flt/inh29121spiroCONTROL MEDIOCRU - adaugat ICSO serfrate WR+ unchi WRRA severaidem 105
Mainov MI71MUAB+RAMonteluk+Flt/inh29120spiroCONTROLATfrateWR/RA+unchi WROBEZ, OASidem 147
Mainov SG40MUWR+RAMonteluk16.5102frateRA+unchi WRPectus escavatum
Mainov SG42MUWR+RAMonteluk16.2103frate WR+ unchi WRPectus escavatumidem 106
Mainov SG44MUWR+RAMonteluk16.5104CONTROLATfrateAB/RA+unchi WRPectus escavatumidem 148-149
Marin DC69MRAB+RAMonteluk18.5109spiroCONTROLATPectus escavatum
Marin EF37FUWR+RAMonteluk1599128NECONTROLAT - ADAUGAT Flt/inh+Deslor+Mometaz/nasRA severa
Marin EF38FUAB+RA1599.5spiroRA severaidem 46
Marin EF40FUAB+RAMonteluk+Flt/inh+Deslor+Mometaz/nas15.6101RA severaidem 109
Marin MA10FRWRMonteluk8.57725M RA, matusa WR
Marinescu AM35FUWR+RAMontelukCONTROLAT PARTIAL - se introd Monetaz/nas
Marin-Gogan M51MURA
Matache M21MRWRMonteluk
Matei A51MUWR+RA625.6%[493]T WR+RABDP
McCollum M87MUAB+RAFlt+Saim/inh+Mometaz/nas+Monteluk26.5132spiroEVOL FAVOR DUPA EXACERB SEVERARA severaDematita
McCollum M88MUAB+RAFlt+Saim/inh+Mometaz/nas+Monteluk26.5132spiroRA severaDematita
McCollum M88MUAB+RAFlt+Saim/inh+Mometaz/nas+Monteluk26132RA severaidem 112 si 113Dematita
Meita D101MUABFlt/inh HD29134spiro/paneluri+>>T dermat M RA
Meita D101MUABFlt/inh HD29134spiro>>EVOL FAVORT dermat M RAidem 95
Meita D103MUAB[exacerb]+RA29134spiroidem 153, 154
Mereuta R168MUAB+RA50.4164spiro/ +polen
Mereuta R168MUAB+RA50164spiroidem 86
Mihai T72MUWR+RAMonteluk20116Hipertrofie adenoamigdaliana - coblatie
Mihai T73MUWR+RAidem 98
Mirea AM150MUTC+RA56154spiroTRAHEOMALACIE, Emotiv, depresiv; teratom operat
Mirea AM151MUTC+RA56154spiroTRAHEOMALACIE, Emotiv, depresiv; teratom operatidem 218
Mirea AM152MUTC+RA56154spiroCONTROLATTRAHEOMALACIE, Emotiv, depresiv; teratom operatidem 148, 149
Mirea RMUWR
Mocanita VM60MUTC+RA
Munteanu M204FUAB+RAspiro/poz par pisicaDermatita
Munteanu M206FUAB+RAspiro/poz par pisicaidem 162Dermat
Murata A81MUWR+RAspiro
Naftan DG54MUWR+RAMonteluk+Deslor6594%T RARA severa
Naghy N69FUAB+RAFlt/inh+Mometaz/nas19.5118spiroM RARA severa2 exacerb in 5 luni
Naghy N69FUAB[exacerb]+RAFlt/inh+Mometaz/nas19.5118spiroRA severaidem 175
Naghy N70FUAB+RAFlt/inh+Mometaz/nas+Deslor20118spiroM RARA severaidem 175. 178
Naghy N71FUAB+RAMonteluk+Flt/inh+Mometaz/nas+Deslor21119spiroCONTROLATM RARA severaidem 123,124, 125
Naghy N71FUAB+RAMonteluk+Flt/inh+Mometaz/nas20119spiroCONTROLATM RARA severaidem 165-168
Neacsu P17MUTCPneumonii recurente - deficit imuniv A+G select
Neagu AF63MUWR+RA1919Pectus escavatum
Nica TA25MUWR+RAMonteluk17.2EVOL FAVORDermatita ++
Niculae AM42MUWR+RA16.5101RA severa
Niculae AM43MUWR+RAMonteluk16r adv FLTinhEVOL FAVORO CRIZA SEVERAidem 103
Niculeasa MT54FUTC+RA17
Nita-Manu MA48MUWRFlt/inh EPISODICEVOL >3epis WR/an
Novac TMUAB19.5117.8Limfom Hodgkin
Obiziuc A44MUWR+RAFlt/nas21.5112idm 57
Obiziuc A45MUWR+RAFlt/nas21.5112idem 4
Ocheana DA62MRRA17.5113poz pt acarieni2864.20%
Oprea AM55FRTC+RA21.5116spiro
Oprea EA133FRAB+RAMonteluk58144spiroCONTROLATOBEZITATE
Palos VD24MUWR
Pandaru-Rugina D15MURC10.7frate WRStridor laring cong
Pandaru-Rugina MA38MUWR+RAMonteluk16102.5spiro
Pandaru-Rugina MA40MUWR+RAMonteluk16103spiro
Pantile TC83MRWR+RAMonteluk+Flt/inh+Mometaz/nas20119spiroO ser
Pantile TC89MRAB+RAMonteluk+Flt/inh+Monetaz/nas21.5121spiroCONTROLATidem 141
Parascu A48MRWR+RA26119.5spiro284RA severa
Pascu MV99MUWR+RA37140spiro3.5%[232]T WR M WR+Dermatita
Patrascanu FR42MUTC+RAMometa+Deslor151016.2N
Paun Z30FUWR/exacerb usoarasora cu atopieDermatitaINTERNATA
Paunescu T42MUWR+RAT RA severa, M RA+urticarieDermat
Pedrazzini34MRWR+RAFlt/inh+DeslorAgit MontelukO seridem 74
Pedrazzini35MRWR+RAFlt/inh+DeslorRA severaidem 14
Petrescu DA93MUWR+RA21.5125poz acarieni780/234015%
Petrescu J36FUAstm+RAMonteluk+Flt/inh
Picu AE60FUWR16.5104.5ADHD
Pirjolescu FS64FUTC+RAMonteluk+Mometaz/nas25118CONTROLAT
Platteeuw L163MUABFlt/inh63.5180spiroConvalescent Pneumonie cu r pleurala si HRB
Polifrone SM85MUWR+RA24123.7spiro>>
Pop AF74MUWRMonteluk36131OBEZ, hiperemotiv, sechele PC
Popa M54FRWR+RA16104
Popescu A122FRWR+RAMontelukspiro
Popescu AMG88FUAB+RAFlt/inh HD+Monteluk18118spiro/ poz mucegai1256/1788RA severaastm sever
Popescu AMG90FUAB+RAFlt/inh HD+Monteluk18118spiro/poz mucegai1256CONTROLATRA severaidem 189Astm sever
Popescu EM41FUWRMonteluk13.898
Popescu R53MUTC+RA18.5105
Popescu S97MUAB+RA25125spiro808
Popescu VA105MUTC+RAMonteluk+Mometaz/nas+D330130.5232HipoCa
Posea R34MUWR+RAMonteluk+Mometaz/nas14100478Dermat
Posea R35MUWR+RAMonteluk+Mometaz/nas14101478idem 221Dermatita
Puiu CLMUWR+RA23.5119
Radu AAMUAstm+RAspiro
Radu AV158MUTC50155spirofrate TC si EIB
Radu MS37MUWR indVSUPRAPOND
Radu SA121MUTC+RA40139spiro/poz polen238frate TC si EIB
Radulescu MIFUAB+RALoratadina30134spiro25.82.48%mama RA
Radulescu MIFUABMontelukspiroidem 111
Rangu AG41FWR+RA
Rizea DC82MRTC+RA27.7128
Roman E28MUTC13
Sandulescu T85MUWR+RAMonteluk22.2120spiro84CONTROLATDermatita
Sebes LV44MUWR+RA15.5101.5IPLVDermat
Secula TI75MUWR22.3119.5bunica astmDermatita
Setareh SFUTC+RA21.5116RA severaDermat
Simion M57MUAstm+RAMonteluk+Flt/inh+Deslor16375RA severa
Sisu VC48MUWR+RA711RGEDermat
Sisu VC49MUWR+RAMonteluk17105711RA severa
Sitaru ARMRWRpoz par hamster280
Sitaru EDFRWR+RAfrate WR, sensibilizat par hamsterDermat
Sofron D90FRTC+RAMometaz/nas27128spiro6.2VCD
Stan MG41MUWR+RA14.597alergie medic - beta-lactami
Stancescu DG79MRAB20119poz pt acarieni
Stanciu A43FRWR+RA15O ser
Stancu MT94FUAB[exacerb]+RAFlt/inh HD + SABA30138spiro/poz par pisica, calNECONTROLAT - dat ICS+LABA [Symbicort]Dermat++
Stancu MT95FUAB+RASymbicort [ICS+LABA}30138spiro/poz par pisica, calCONTROLAT - scos Symbicort - ICS HD+Montelukidem 243Dermat++
Stanga AM43MUWR+RAMonteluk161025.60%Bunica RARA severa
Stanga AM46MUWR+RAMonteluk+Mometaz/nas+Deslor16104EVOL FAVOR5.60%Bunica RARA severaidem 139
Stanga AM49MUWR+RaMonteluk+Mometaz/nas17107CONTROLAT5.60%Bunica RARA severaidem 244, 245
Stejar T74MRAstm+RAMonteluk21.5121spiro157.8
Stejar T78MUAB+RAMonteluk21.5121spiro/poz polen175.8CONTROLAT AB, pt RA - Mometaz/nasO seridem 226Dermat
Stoica R4MUWR7
Stoican ACMRWR+RA19110
Stoicescu T31MUWR+RAMonteluk17106>>CONTROLATDermatita
Suta DC8MUTC+RADeslor9M dermatita, surori cu WR,
Szilagy A14MUWR+RAMonteluk11.4RA severaDermat
Szilagy DO44MUWR+RA94O ser6%IgA si G usor39.5C[367 PACIENTI FEBRILI esantion IAN - NOV 2012]
PACIENTI NETERMOMETRIZATI[141 PAC din 1753 Prezentati - esantion Ian - Nov 2012]
Caz Mara A 4 ani 9 luni Mesajul mamei : Atasate sunt analizele recoltate miercuri 07 nov, in a 7-a zi de raceala (zilele 1 si 2 cu febra 38.8C, zilele 3 si 4 cu 37.5C si zilele 6 si 7 cu temperatura normala ziua si cu 35.5C! insotite de transpiratii reci noaptea -- urmate de inca 2 zile cu 35.5C si transpiratiidoar noaptea). []Am asteptat sa-i fac analize in stare de sanatate, dar numai in muci si raceli o tine
Caz Mara A 4 ani 9 luni Asteptarile / ingrijorarile materne:
Febra este o cauza de ingrijorare [vezi precizia masuratorilor si notarea valorilor!]
Parintele vrea certitudini analize
Investigatii
Raspunsul medicului
Investigatiile evoca natura virala a bolii. Mai ales prin numarul relativ scazut de leucocite.
Nu exista elemente de deficit imunologic (valorile diverselor imunoglobuline sunt normale si complementul seric este normal) [...]
Raspunsul medicului [...]Pana aici nimic semnificativ! Un copil care nu are elemente de infectie acuta NU TREBUIE termometrizat.
Din pacate va mai face viroze. Suntem la inceputul iernii. Pastrati-va energia pentru afectiuni acute...
Ce facem la un copil febril ?Antibiotice ??Investigatii ??Altceva ?!
Care sunt optiunile terapeutice imediate ?
FEBRA LA COPILRolul antitermicelor in preventia recurentei convulsiilor febrile
NU scad semnificativ statistic riscul de recurenta *22.7% recurenta cu AT & 24.4% cu placebo
* Rosenbloom E et al - Do antipyretics prevent the recurrence of febrile seizures in children? A systematic review of randomized controlled trials and meta-analysis. Eur J Paediatr Neurol.2013 May 21. pii: S1090-3798(13)00065-2
FEBRA LA COPILRolul antiinflamatoarelor nesteroidiene in IACRS
Mai degraba NU*Nu reduce evolutia boliiNu scade scorul de simptome
* Kim SY et al - Non-steroidal anti-inflammatory drugs for the common cold. Cochrane Database Syst Rev. 2013 Jun 4;6:CD006362.
PROTOCOALE S R Ped
FEBRA LA COPILCe putem administra la copil [SRPed]Paracetamolpo sau IR 10-15 mg/kg/doza la 4-6hiv 15 mg/kg/doza la 6h(poate face IH mortala!!)Ibuprofenpo 5-10 mg/kg/doza la 6-8hKetoprofenpo 0.5 mg/kg/doza x 3 Schemele alternative la 3h cu Ib+Paracetamol
Agentia Nationala a Medicamentului
Agentia Nationala a Medicamentului
Asocierea alternativ a Ibuprofen si paracetamol este eficaceNabulsi MM, et al. BMC Med 2006;4:4.Metodologia folosit a putut demonstra o non-inferioritate n administrarea alternativ ibuprofen-paracetamol n comparaie cu ibuprofen n monoterapie
Asocierea Ibuprofen i Paracetamol se dovedete a fi un regim antipiretic eficientHay AD, et al. BMJ 2008;337:a1302.Terapia combinat se dovedete a fi superioar paracetamol n a scdea perioaadei de manifestare a febrei, efect manifestat n primele 4 ore de dup administrare
Alte Optiuni
Paracetamol iv [Perfalgan]7mg/kgc/doza !!!!Dilutie 1:10 la copil micPev lenta cel putin 30 min [nu iv flush!]Diclofenac supozitoare [Voltaren 50mg]1.5 mg/kgc doza( FEBRA CU OTITA,DURERI FT MARI!, SE PUNE SEARA LA CULCARE!)
FEBRA IN PATOLOGIA PEDIATRICAPLANUL LUCRARIIINTRODUCEREBOLI FEBRILE LA COPILTRATAMENT ANTITERMICEFECTE ADVERSECONCLUZII
EFECTE ADVERSEEfectele adverse ale antitermicelorDEPINDE de concordanta prescriptiei cu medicam cumparat!Doza trebuie sa fie corectaHipotermie fizica
EFECTE ADVERSE
Acestea depind si de concordanta prescriptiei cu medicamentul cumparatAntitermicele PENTRU copil trebuie cumparrate de la farmacie!9% din recomandarile de AT in alte facilitati decat farmacia au fost eronate*
* Bardage C et al - Non-prescription medicines for pain and fever--a comparison of recommendations and counseling from staff in pharmacy and general sales stores. Health Policy.2013 Apr;110(1):76-83.
Managementul febreiNu se recomand metode fizice de reducere a febrei [desi populare si frecvent uzitate] DECAT la non-responderi Majoritatea metodelor fizice de scdere a febrei se pot asocia cu reacii adverse severe: cretere paradoxal a febrei datorit vasoconstriciei; tremurturi i frisoane prelungite cu pierdere crescut de energie; hipoglicemie sever, com, deces (mpachetrile cu alcool).Management of Fever in Children: Summary of the Italian Pediatric Society Guidelines. Clinical Therapeutics Volume 31, Number 8, 2009
Managementul febrei
mpachetrile cu ap cldu nu se asociaz cu aceste efecte adverse severe, dar pot determina disconfort.!!!! Sau in cadita!Management of Fever in Children: Summary of the Italian Pediatric Society Guidelines. Clinical Therapeutics Volume 31, Number 8, 2009
FEBRA IN PATOLOGIA PEDIATRICAPLANUL LUCRARIIINTRODUCEREBOLI FEBRILE LA COPILTRATAMENT ANTITERMICEFECTE ADVERSECONCLUZII
CONCLUZIIFebra este foarte frecvent intalnita!Prima cauza de prezentare la MFA doua cauza de spitalizare la copilFebra este temuta fever phobiaDe parintiDe medici
CONCLUZIIParintii cat si medicii rezoneaza favorabil la ideea de medicatie hipotermizanta SIGURA & EFICIENTA!!!Ibuprofenul intruneste aceste expectativeSingur [in doza 10mg/kgc x 3/zi]Sau in asociere cu Paracetamol [de prima intentie in febra + durere]
CONCLUZIIParintii si unii medici considera rezonabila administrarea de prima intentia a antibioticelor la copilul febril Copii cu febra care sunt atat de sanatosi incat pot fi tratati la domiciliu au nevoie de antibioterapie in conditii EXTREM de rare.
*Pacientul copil febril.este foarte de temut!.*1 luna- 2luni.38,1 grade11 2luni- 3 luni.38,2 grade3 luni. 37,6- 37,8!!Masurate rectal!!...nu la subtioara nu suzete cu termometru!! la nastere poti avea putina temp mai mare deoarece nasterea este un traumatism in sine!....*3,7 episoade/ an la COPIL!!....FRECVENTA DUBLA la cei cu varsta < 4 ani!!La copil cu cat se face mai mare incep sa dispara episoadele de febra!!Un copil face in medie 4 episoade de febra evidente/ an*Un copil de 3-4 ani s-a mers la doctor mult mai putin!!!....parintii s-au obisnuit reactioneaza prin modalit diverse *Febra mare este 39, 5 gradeeee!!*Febra este un proces destul de bun fiziologic!!..Febra in sine nu este o boalaUn mec fiziologic destul de necesarIncetineste replicare bact si virala .exemplu clasic gripa!!!....vaccinurile antigripale, se pun ca un spray in nas!*Practic: modalitatea cea maibuna este cea rectala!1. Cu term elctronic!!..... Cele cu coloana de mergcur sunt extrem de precise dar prin reglementari nu se mai folosescla copil!.
La copilul prescolar mai mare poate fi masurat sublingual!!
La copilul scolar se pune la subtioara!
*La scoalar: axilar si oral!!*Aceste device=uri sunt incorecte.nu ft bune!!.
*Infectiile la 0-1 an.60 %1-4 ani 36 %5-15 ani 20%
Ft multe dn recomand antibio nu sunt facut cum ar trebui!!*Alte cauze de febraL boli reumatismale( vasculite)IntoxicatiiAnomalii termoreglareFebra factitiala!!( febra fara focar).consult ORAL si sumar de urina!!....se adm creta(carbonat de calciu ) in apa baut se face febra!!!
*Mecanisme compensatorii:ABC!!....SA FACEM UN SCOR GLASGOW!! Hiporeactiv somnolent
Trebuie sa ne sperie impactul asupra functiilor vitale( nu neaparat marimea febrei)Examen clinic.puls saturatie FR..Starea generalaSi scorul Glasgow!!
*Nn si sugarul mic < 3luni ( sunt mai speciali) daca acesti au sumar de urina normal atunci riscul este minuscul!!!....si poate fi anticipat prin masurarea PCT!!! PROCALCITONINEI!!( creste in boli bacteriene!!!)
DACA EXMENUL CLINIC ESTE NORMAL SE FACE HEMOCULT UROCULTURA.SI PUNCTIE LOMBARA DACA ARE SCOR GLASGOW MIIC!!!
MAI PUTIN EFICIENT PRIN MASURAREA CRP!! Mai ieftin este masurarea PCR!!
*INCIDENTA CAZ DE INFECTII (0-5 ANI )PNEUMONIASEPTICEMIAITUMENINGITAARTRITA SEPTICAOSTEOMIELITAINFECTII BACTERIENEENCEFALITA!!BOALA KAWASAKI
DACA LA Ex clinic este normal..ii dam sa faca o urocultura( deep stick) acesti se schimba la culoare. Daca nu are modifi de sumar de urina..un copil cu febra fara focar este ft putin probabil sa aibe o bacterie!!
*Criterii Rochester la pacientii cu febra!!!.....SEVERITATE REDUSA ( CARE AU RISC FT MIC DE BOAA BACTERIANA SI NU NECESITA ANTIBIOTICE)
-COPIL arata BINE!!( agitat nervos sa-l doara urechea)Copilul a fost inainte bine!.....nascut la GA>37 sapt..fara antib perinatal. Fara tratam pentru bilirub neexplicatanu a primit antib de curand. fara alte boli cronicenu a fost internat.. fara spitalizare mai multa decat a mamei)Infantul nu are semne evidente de infectie piele.os ureche!!Sugarul are aceste valori: leucocite: 5000- 15000/metrucub!!