Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Emergency Med > Fever > Flashcards

Fever Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

What is a fever

A

Deliberate hypothalmus controlled reflex elevation of body temperature in response to some disease or illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are considered fevers in children and adults

A 
Children:
        100.4 F  (38 C)      Rectally
        99.5 F (37.5 C)   Orally
         99 F    (37.2 C)   Axillary
Adults:    99.5 F  (37.5 C) Orally
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Epidemiology of Fever

A

Third most common reason for ED visits.
Some serious infections do not present with fever.
Absence of fever does not exclude serious illness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

as the muscle tone & circulating inflammatory mediators increase what happens?

A

Myalgias & arthralgias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is hyperpyrexia

A

Uncontrolled heat accumulation overwhelming the compensatory mechanism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does hyperpyrexia represent?

A

critical imbalance of heat producing & heat dissipating processes.
Should be considered at temps > 105 F degrees or 40.5 C degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What could cause hyperpyrexia

A

excess heat generation,
impaired heat loss, combination of both, or
direct CNS insult.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some causes of hyperpyrexia

A 
Exertional Heat Stroke
DT’s
Stimulant Abuse
Thyroid Storm
Pheochromocytoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

4 causes of impaired heat loss

A

Classic Heat Stroke
Phenothiazines
Anticholinergics
Spinal Cord Injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

4 causes of CNS dysfunction

A

CNS Trauma
Tumor
Encephalitis
Stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some red flags when thinking hyperpyrexia

A 
Rales, Rhonchi, or Asymmetry of Lung Sounds
CVAT
Abdominal Pain
Cardiac Murmur & Splinter Hemorrhages
Headache, Nuchal Rigidity, Confusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some associated symptoms for hyperpyrexia

A 
ST
Ear pain
Dysuria, Frequency, Urgency
Penile/Vaginal discharge
Dyspareunia
Flank Pain
Pelvic Pain
Headache
N/V/D
Rash
Skin Infection
Nasal discharge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

3 factors that could effect temperature

A

Variation
Cold Drinks or Weather
Repeat temp if you are not sure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are 3 vital sign changes that can be seen with a fever?

A

Increased pulse & respiratory rate can be seen with fever
Decreased O2 Sat
Decreased BP may have correlation with sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are 5 CNS changes that can be seen with fever

A 
Nuchal Rigidity/Resistance to Neck Flexion
Mental Status Changes
Papilledema
Bulging Fontanelles
Focal Neuro Abnormalities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the most common infected site that causes fever

A

upper respiratory tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Lower Resp Tract infection

A

bronchitis and PNA
rales, rhonchi, wheezing
sputum production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What should you be thinking with RLQ pain

A 
Appendicitis
PID
UTI
Abscess
Ovarian
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What 4 things should you be thinking with LLQ pain

A

Diverticulitis
Ovarian
PID
UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What should you be thinking with RUQ pain

A

Murphy Sign/Cholecystitis
Colitis
Abscess
Enlarged Liver… Hepatitis
SBO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

LUQ pain what 4 things should be considered?

A

Pancreatitis
SBO
Colitis
Abscess

22
Q

epigastric pain what should be considered

A

Cholecystitis
Pancreatitis
SBO
Pneumonia

23
Q

Where to look for pressure sores

A 
Sacral
Hips 
Perineum
Feet especially in DM
Look for drainage, erythema, crepitus
24
Q

What are signs of infection on the skin

A 
Bulls Eye Rash
Petechial Rash
Maculopapular Rash
Crusted Vesicles
Cellulitis
Diffuse Erythema
25
Q

noninfectious causes of fever

A

thromboemboli
tumor
immunological dz
heat stroke

26
Q

What labs should be ordered when someone presents with fever

A

CBC - neither sensitive nor specific to distinguish bacterial from non-bacterial
WBC - > 15,000 suspect bacterial illness
Can also be elevated in steroid use, myeloproliferative disorders, & pregnancy
WBC important to exclude neutropenia

27
Q

What bands would be elevated in bacterial infection

A

neutrophils/polys, bands elevated in bacterial infection

28
Q

When should a stool culture be ordered?

A

Use in patients with diarrhea
Suspected C-diff, Campylobacter, Salmonella, & Shigella
Also useful in identifying Ecoli
O&P for Giardia

29
Q

In what patients is an LP indicated?

A

suspected CNS infection with symptoms of fever, altered MS, HA, neuro changes, meningismus, localized spinal tenderness
Use care not to contaminate with skin flora
Empiric abx should be initiated prior to the LP

30
Q

What does the LP order set consist of?

A

Tube 1 - cell count & differential
Tube 2 - protein, glucose
Tube 3 – gram stain, Bacterial Cx, Viral Cx (Herpes)
Tube 4 – antigen, repeat cell count & differential

31
Q

Joint Aspiration

A

Use on swollen, red, hot joints
Send for cell count & differential, gram stain, culture, & crystals
WBC > 50,000 suspicious for septic joint
Bacterial infection can occur with lower WBC

32
Q

What does a culture have a high rate for detecting?

A

Staph & Strep,
not Gonorrhea/always check for penile or vaginal discharge
ESR &/or CRP may be of assistance

33
Q

What is a chest x ray gold standard for?

A

PNA

PA and lateral views

34
Q

what does hyperinflation signify?

A

COPD

35
Q

When would you order an xray of soft tissue in the neck

A

Epiglottitis – thumbprint replaces normally thin epiglottic shadow
Retropharyngeal Abscess – prevertebral soft tissue thickening

36
Q

What needs to be done it IV contrast is given?

A

BUN/CR if IV contrast to be given

Metformin dose needs to be held for 48 hours if IV contrast is given

37
Q

Treatment for fever– antipyretics

A

acetominophen
motrin
toradol

38
Q

Treatment for fever–fluids

A

Initiate in patients with fever who appear ill or dehydrated
Provides modest cooling effect
Indicated in vomiting & diarrhea
Reduces tachycardia & increased thirst secondary to fever

39
Q

Treatment for fever– abx

A

depends on the diagnosis, pathogen

40
Q

Treatment for fever– cooling measures

A

Tmax > 105 F (40.5 C) is more than likely Hyperpyrexia

Immediately lower body temp by removing clothing, cooling blankets, & ice packs to the groin & axilla

41
Q

Fevers in the elderly

A

Up to 1/3 of elderly with systemic infection will not have a fever
Most common sources UTI, respiratory tract, & skin
confusion, weakness, unexplained falls, & persistent tachycardia are indications of infection in the elderly

42
Q

what is neutropenia

A

blood neutrophil count < 500 cells/mm3

Neutrophil count < 100 cells/mm3 at increased risk of infection

43
Q

Febrile neutropenic patients need

A

Isolated
Reverse Precautions
CBC & all cultures
Broad spectrum abx Ceftazadime or Imipenem
Add in Vancomycin for all patients with indwelling foley
catheters

44
Q

Fevers and spinal cord injury

A

Predisposed to UTI’s, pneumonia, & infected decubiti
Colonization in bladder with indwelling foley catheters & suprapubic tubes
May suffer from autonomic hyperreflexia with intermittent excessive sweating contributing to thermal instability

45
Q

what is most likely cause of fever 24-48 hours Post Surgical/Post Partum

A

Atelectasis most likely cause 24-48 hours postop

46
Q

what warrants careful eval for infection in neonates

A

altered mental status

47
Q

management labs for infant less than 28 days

A

CBC
Cath for UA & UC
Blood cx
LP

48
Q

management for infant greater than 28 days to 3 months

A 
Low Risk –
previously health
no focal bacterial infections on PE 
negative lab screening
including WBC 5000-15000,
neutrophil & band count < 1500, UA < 10 WBC/hpf 
no bacteria on urine gram stain
CSF < 8 WBC/hpf & no bacteria seen on gram stain
Only 1.4% chance of having SBI
49
Q

management for infant greater than 36 months

A

Immune system is developed so that SBI is much less common
Incidence of occult bacteremia increases with higher temps & elevated WBC
Lab studies are dictated by clinical presentation

50
Q

management for infant greater 3 months to 36 months

A

No single lab can exclude bacteremia
Height of WBC count is of some value
Blood cx indicated if WBC > 15,000
Catheterized UA in all male infants up to 6 months if circumcised & 1 year if uncircumcise with temp> 39 C
Temp < 39 C without a source no labs are needed unless clinically indicated

51
Q

How do you manage fever in children

A

Early antipyretic therapy
Acetaminophen 15 mg/kg po or pr q 4-6 hours
Ibuprofen 10 mg/kg po q 6-8 hours
May alternate acetaminohen & ibuprofen every 3 hours
Avoid ASA because of risk of Reye Syndrome
Do not start empiric abx unless a complete sepsis workup is performed including LP

52
Q

when to admit children with fevers?

A

Admit toxic appearing children regardless of age
Any febrile infant < 28 days needs admission & empiric abx after sepsis workup
Give thorough discharge instructions to parents including follow up & return for worsening of sx

Emergency Med (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions