8. Fever Flashcards
where is body temp controlled?
in preooptic area of hypothalamus
how is blood temperature changed?
vasomo change
shivering
change in metabolic heat production
behavioural change
“Significant fever” Rosen’s defn
> 38.3
Hyperthermia defn
elevation of the tem- perature related to the inability of the body to dissipate heat
typically if gr than 41
Fever defn
elevation of body temperature caused by thermoregulatory path- ways in response to infections and certain other medical circumstances
Examples of endogenous pyrogens (causing fever)
ck released by leukocytes in response to inf, inflamm, neoplastic processes
Exogenous pyrogen examples
bacterial and viral products, toxins
How do toxins induce fever?
stimulating cells of imm system to release endog pygorens like CK IL1, 6, TNF and interferon to hypothal to induce PGE2
this then incr set point of temp range
DDX of noninfectious causes of fever - critical ddx 8
AMI
PE or infarct
ICH
cva
NMS
thyroid storm
acute adrenal insuff
transfusion rxn
pulmonary edema
DDX of noninfectious causes of fever - emergent dx
HF
dehydration
recent seizure
sickle cell disease
transplant rejection
pancreatitis
dvt
DDX of noninfectious causes of fever - nonemergent dx 6
drug fever
malignancy
gout
sarcoid
crohn’s
postmyocardiotomy syndrome
what demographics/factors blunt febrile response?
age
malnutrition
immunosuppression
chronic disease
What positive effects does fever add?
incr chemotaxis
decr microbial replication
improve lymphocyte function
inhibit growth of some bacteria and viruses
what causes chills?
mismatch between set point temp of the hypothalamus is incr and body temp remains N
DDX Infectious causes of fever -respiratory - critical
bacterial pneumonia with resp failure
DDX Infectious causes of fever -respiratory - emergent
bact pneumonia
pta
rpa
epiglottitis
DDX Infectious causes of fever -respiratory - non emergent
OM
sinusitis
pharyngitis
bronchitis
influenza
tb
covid19
DDX Infectious causes of fever -cardiovascular - emergent
endocardiis
pericarditis
DDX Infectious causes of fever - GI - critical
peritonitis
DDX Infectious causes of fever - GI - emergent
appendicitis
chole
diverticulitis
intraabdo abscess
DDX Infectious causes of fever - GI - nonemergent dx
colitis
enteritis
DDX Infectious causes of fever - GU - emergent
pyelo
TOA
PID
DDX Infectious causes of fever - GU - non emergent
cystitis
epididymitis
prostatitis
DDX Infectious causes of fever - neurologic - critical
meningits
cavernous sinus thrombosis
DDX Infectious causes of fever - emergent dx
encephalitis
brain abscess
DDX Infectious causes of fever - skin and soft tissue - emergent dx
cellulitis
infected decubitis ulcer
soft tissue abscess
DDX Infectious causes of fever - critical dx in system disease
sepsis
septic shock
meningococcemia
DDX Infectious causes of fever - emergent dx
influenza
covid19
Approach to critically ill febrile pt in ED: unstable
ie ams, resp distress, HD instable
rapid reuss: ABC, o2 monitors,
cool if needed, abx
hx and PE
Initial testing if febrile and no PE source?
ua
cxr
cbc
If initial testing nil acute in febrile pt, consider further diagnostics of what categories (4)
misc
malignancy
autoimm
infectious
ct
bl culture
LP
SIRS defn
two or more of these criteria: temperature greater than 38°C or less than 36°C; heart rate greater than 90 beats/min; respiratory rate greater than 20 breaths/min or Paco2 less than 32 mm Hg; and leukocyte count greater than 12,000/μL, less than 4000/μL, or more than 10% immature (band) forms.
quick Sequential Organ Failure Assessment : includes? (3?)
(respiratory rate of 22/min or greater, altered mentation, or sys- tolic blood pressure of 100 mm Hg or less
- Which three body systems are the target of more than 80% of bac- terial infections in patients older than 65 years?
a. Central nervous system, respiratory system, genitourinary sys-
tem
b. Central nervous system, respiratory system, skin and soft tissue
c. Central nervous system, urinary system, skin and soft tissue
d. Respiratory system, genitourinary system, skin and soft tissue
d
- Of the cases of functional decline in nursing home patients, 75% are due to which of the following?
a. Congestive heart failure
b. Coronary artery disease
c. Dementia
d. Infection
d
- An 85-year-old man is brought to the emergency department (ED)
by his daughter, who says that he has had a fever and has been eating less than normal for 2 days. The patient has a history of hypertension and severe dementia. He can provide no useful infor- mation. His present temperature was recorded by the triage nurse to be 38.5°C (101°F). The remainder of his vital signs are within nor- mal limits. The only abnormal findings on physical examination are slightly dry mucous membranes, confusion, and poor social inter- action. The daughter confirms his mental status to be at baseline. Which of the following are the two most important ancillary tests to perform in this patient?
b
A 65-year-old man presents after “briefly collapsing” at a nearby
bus stop. On arrival, he is confused, opens his eyes spontaneously, and follows simple commands. A medical information card found in his wallet reveals a history of hypertension and gout. Vital signs reveal a blood pressure of 95/50 mm Hg, heart rate of 95 beats/min, respiratory rate of 24 breaths/min, temperature of 41.5°C, and arte- rial oxygen saturation (Sao2) of 95%. His finger-stick glucose level is normal. Pertinent physical examination findings include pallor, dry mucous membranes, Glasgow Coma Score (GCS) of 14, and ataxia. An intravenous bolus of normal saline is started. Which of the following is the most appropriate next step in the management of this patient?
a. Administerbroad-spectrumantibiotics.
b. Mist the patient with water and place him in front of a fan. c. Obtain a head CT scan.
d. Perform a lumbar puncture.
b
