Chapter 8 - Fever in the Adult

Question 1

HR ↑ x_____ per ↑1’C

Fever w ↓HR (5)

Answer 1

↑HR x10bpm per 1’C

typhoid fever
brucellosis
leptospirosis
Lyme
Rheumatic fever

Question 2

Fever pathophysiology
– What causes rigors
– What causes chills

Answer 2

Cytokines go to HT = ↑PGE = ↑T setpoint (via VC, ↑MR, shivering)

Chills = set point mismatch T < new setpoint

Sweats = set point mismatch T> normalized setpoint

Question 3

Tylenol for fever in sepsis
28d mortality =
14d mortality =

Hard indications to Tx fever in sepsis

Answer 3

Recent MA data
no benefit @ 28d mortality
benefit <14d mortality

T>41 b/c neuronal damage

Question 4

SIRS (5)

qSOFA (2)

Answer 4

Sn 80 & Sp25
- T>38
- HR>90
- RR>20
- PaCO2 <32
- WBC<4 >12 or >10%bands

Sn 40 & Sp80
- RR >22
- AMS
- SBP<100

Question 5

r.o non-infectious fever LTs (15)

Answer 5

1) ACS
2) PE / VTE
3) ADHF / Pulm edema
4) ICH
5) CVA
6) Thyroid
7) NMS / SS
8) Adrenal insufficiency
9) Tox
10) Pancreatitis
11) Transfusion Rxn
12) SC Crisis
13) Malignancy
14) Gout
15) Sarcoid