Questionnaire/history: History from? Date of birth verified? Fever since? Maximal temperature? °C Temperature now? °C - T < 36° C? Temperature objectified with fever thermometer? - Infra-red tympanic thermometer? - Electronic thermometer in the axilla? - Chemical dot thermometers in the axilla (not recommended for healthcare professional) - Forehead thermometer? - Oral route? - Rectal route? Associated symptoms suggesting an underlying cause of fever? Past medical history (eg impaired immune system, trauma, surgery or invasive procedures in the last 6 weeks)? Vaccination history? Current medication? Drug allergies? Examination: Behaviour: Normal behaviour? Alert? Active? New-onset altered behaviour or mental state? Acute deterioration of functional ability? Objective evidence of altered behaviour or mental state? Colour of skin, lips and tongue: Normal? Mottled or ashen appearance? Blueish skin, lips or tongue? Temperature: - T < 36°C? Breathing: Dyspnoea? RR normal? RR 21-24 bpm? RR ≥ 25 bpm? New need for 40% oxygen or more to maintain saturation more than 92% (or more than 88% in known chronic obstructive pulmonary disease)? Heart rate: HR normal? HR 91-130 bpm? HR ≥ 130 bpm? New onset arrhythmia? Cor: H1+2+0? Hydration and circulation: Not passed urine in the past 12-18 hours? Not passed urine in previous 18 hours? Systolic BP 91-130 mmHg? Systolic BP ≤ 90 mmHg? Other: Ears? Throat? Cervical lymph node enlargement? Abdomen: - Soft? - Organomegaly? - Tenderness? - BS normal? Non-blanching rash? Signs of potential infection (eg redness, swelling, discharge at surgical site or breakdown of wound)? Neck stiffness? Brudzinski's sign? Kernig's sign? Urine dipstick? Management: According to clinical situation For home care: Advised: - To offer regular fluids - To encourage the child to drink more if signs of dehydration (sunken eyes, absence of tears, dry mouth, poor overall appearance) - Paracetamol (Calpol) 4-6 hourly (max 4 doses per 24 hours) if distressed, max 4 doses per 24 hours, to alternate with ibuprofen (Nurofen) if no vomiting and distress persists or recurs before the next dose is due - To call back if fit, develops a non-blanching rash or person becomes less well or carers are more worried - Review own GP if no improvement or ongoing symptoms Resource(s): NICE Guideline 51: Sepsis: recognition, diagnosis and early management