Fever

Question 1

What makes your temp. rise?

Answer 1

• Infection: bacterial, viral, fungal, protozoal
• Idiopathic
• Pathologic
• Vigorous activity
• Drug fever

Question 2

Pathophysiology

Answer 2

• Infections cause pyrogen release
• Pyrogens trigger PG synthesis in the hypothalamus
• Prostaglandin (PGE2) increases the set point -> fever (>100F)

Question 3

Fever for Adult

Answer 3

• Oral: >99.5
• Temporal: >100.1
• Tympanic: >100
• Axillary: >99
• Rectal: > 100.4

Question 4

Oral Temps

Answer 4

Pros
• Preferred for adults and older kids
• Less invasive
• Faster than rectal temp (5-30 sec

Cons
• Need to keep under tongue with tight seal
• Young children may not be able to cooperate
• Affected by activity, smoking, hot/cold drinks

Question 5

Rectal Temps

Answer 5

Pros
• “Gold standard”
• High sensitivity and specificity to core temp
• Preferred for age <6 months

Cons
• Invasive
• Slower than oral and axillary
• Risk of perforation or retention 
• Relative contraindications

Question 6

Axillary

Answer 6

Pros
• Non-invasive
• Easy for infants and children

Cons
• Less reliable vs. oral and rectal
• Variable accuracy depending on technique
• Incorrect placement, poor seal, moving arm

Question 7

Tympanic

Answer 7

Pros
• Closer measure of core temp vs. oral
• Non-invasive and fast (5-30 sec)
• Easy route for children

Cons
•  More expensive
•  Need correct position in ear canal
• Not recommended for age <6 months
• Affected by wax, otitis media, ear canal size

Question 8

Temporal Temps

Answer 8

Pros
• Can accurately measure core temp
• Non-invasive and fast (few seconds)
• Good option for kids

Cons
• Accuracy depends on technique, hair, sweat 
• More expensive
• No touch less accurate than rectal
• Avoid color change – not accurate!

Question 9

WHEN TO TREAT

Answer 9

• Oral temp >100°F with patient discomfort

• Lethargy, decreased activity
• Poor fluid intake or signs of dehydration

Question 10

WHEN TO REFER ADULTS

Answer 10

• Oral temp ≥103°F (or equivalent)
• Persistent fever >3 days ± treatment
• Severe symptoms of infection not self-limiting
• Immunocompromised (e.g., HIV, cancer)
• Risk for hyperthermia
• Impaired oxygen utilization
• CNS damage (e.g., head trauma, stroke)

Question 11

Non-Drug Treatment

Answer 11

• Adequate fluid intake
- Kids: ­ by 30-60 mL (1-2 oz) per hour
- Adults: ­ by 60-120 mL (3-4 oz) per hour
• Wear lightweight clothing
• Remove blankets
• Maintain comfortable room temp (68°F)
• Reduce activity
• Sponging or cool baths not recommended