Fever Flashcards
What temperature is considered a fever?
Greater than 100.4 F
How much can a healthy person’s temperature vary throughout the day?
As much as 3.6 F
When is body temperature the lowest? When is it the highest?
Lowest at 6:00am
Highest at 6:00pm
What method of obtaining body temp is the most accurate?
Rectal
What is the accuracy of oral temperature taking?
Usually underestimates by approx 0.4 degrees F
What method of obtaining body temp is least accurate?
Axillary/temporal
Define malignant hyperthermia
- Hypermetabolism involving skeletal muscle
- Triggered by inhaled anesthetics or succinylcholine
Post-op causes of fever
- Wind (days 1-2 post op, inflamm 2/2 trauma/stress)
- Water (days 3-5, UTIs esp if Foley still in place)
- Wound (days 4-6, cellulitis/abscess)
- Walking (days 5-7, DVT)
- Wonder drugs or Womb (days 7+, drugs reaction or OBGYN infection)
What is most likely cause of fever 1-2 days post op?
Inflammatory 2/2 trauma or stress (WIND)
What is most likely cause of fever 3-5 days post op?
UTIs (WATER)
What is most likely cause of fever 4-6 days post op?
Cellulitis, abscess (WOUND)
What is most likely cause of fever 5-7 days post op?
DVT, thrombophlebitis (WALKING)
What is most likely cause of fever 7+ days post op?
Drug reaction or OBGYN infection (WONDER Drugs or WOMB)
For every 1 degree F increase, how much does HR change?
Increased by 10 bpm
How is metabolism affected by increase in body temp?
Increases 7% for each 1 degree increase
How does fever affect immune function?
Fever enhances immune function and may act protectively
Body temp over 106 degrees F may lead to what?
ICB
Rhabdo
Organ damage
Define delirium
Fluctuating disorder of consciousness
Define left shift
Increased production of immature WBCs (aka bandemia)
What does absolute neutrophil count determine?
Degree of immunocompromise in chemo
When is lactic acid elevated?
When body breaks down carbs to use for energy during times of low oxygen levels (e.g. sepsis)
When should acetaminophen be avoided?
Liver failure
When should ibuprofen be avoided?
Gastric ulcer (dose reduce in renal failure)
Define fever of unknown origin
Fever for over 3 wks with no identified cause after 3 days of hospital eval OR 3 outpatient visits
Etiology of fever of unknown origin
Infections (25-50%)
CT disorders (10-20%)
Neoplasms (5-35%)
Define distributive shock
- Hypotension resulting in compromised end-organ oxygenation
- 2/2 decreased vascular resistance (despite normal circulatory volume)
Define systemic inflammatory response syndrome (SIRS)
2 or more of:
- Oral/rectal temp over 100.9 or under 96.8
- HR over 90 bpm
- RR over 20 or PCO2 under 32
- WBC over 12,000 or under 4,000
Define sepsis
SIRS due to documented or suspected infection
Define severe sepsis
- Septic shock
- Sepsis plus evidence of acute organ dysfunction or tissue hypoperfusion
Mortality rate of sepsis?
Declining but the incidence of sepsis is increasing which results in more annual deaths
Community acquired etiologies of sepsis
- PNA
- UTI
- ABD/GYN source
- Skin cellulitis/abscess
- Meningitis
- Endocarditis (IVDA)
Hospital acquired etiologies of sepsis
- IVs/Foleys
- Intubation
- Ulcers/wounds
- Surgery/procedures
- ICU admission
Etiologies of non-bacterial SIRS
- Pancreatitis
- PE
- Burns
- Fungal
- Viral (flu, CMV)
- Autoimmune (SLE)
- Anaphylaxis
What is RUSH in regards to sepsis?
Rapid Ultrasound for Shock and Hypotension
Sepsis metrics to be completed within 3 hours
- Lactate level
- Blood cultures
- Broad spectrum abx
- Saline
- O2
Sepsis metrics to be completed within 6 hours
CENTRAL LINE
- Vasopressors to maintain MAP over 65
- ScvO2 measurement
- Recheck lactate
- CVP measurement if possible
Goals of sepsis metrics
- MAP over 65
- Urine output over 0.5 mL/kg/hr
- ScvO2 over 70%
- Normal lactate
Empiric abx for sepsis treatment
Ceftriaxone plus Vancomycin
What is CURB-65?
Pneumonia severity scoring
- Confusion
- Urea over 20
- Resp rate over 30
- Blood pressure (SBP under 90 or DBP under 60)
- Age 65+
Define fixed drug eruption
- 1 or more annular erythematous patches
- Normally resolve w/hyperpigmentation and may recur at same site with re-exposure to the drug
Define urticaria
- Hives
- Vascular reaction of skin marked by smooth, slightly elevated wheals
- Pruritus
Define angioedema
-Swelling of deep dermis, SQ or submucosal tissue due to vascular leakage
-Tongue, lips, periorbital
(GI or pulm possible)
Define anaphylaxis
- Shock state secondary to allergen trigger
- Results in hypotension, bronchospasm, GI/uterine contraction, urticaria/angioedema
Describe exercise induced allergic reaction
- Exercise triggers food allergy within 1-4 hrs of eating
- MC wheat, corn, garlic, veggies, shellfish
How to treat mild allergic reaction
- Monitor and IV access
- Benadryl
- Steroids
- H2 blocker
How to treat severe allergic reactions
- 2 IVs, benadryl, steroids, H2 blocker
- Epi
- Albuterol
- Vasopressors, glucagon, intubation may be necessary
Treatment of ACE induced angioedema?
- NOT responsive to traditional allergic treatment
- FFP 2-4 units IV
Define scombroid poisoning
- Improper fish storage
- High levels of histidine in flesh converted to histamine (heat resistant, cooking will not affect it)
Onset of scombroid poisoning
Few mins to hours from consumption of fish
Clinical presentation of scombroid poisoning
- Rash and flushing of face/upper body resembling a sunburn
- Diarrhea, vomiting
- Palpitations, sweating, HA
- Burning or swelling of mouth
- Metallic taste
Treatment of scombroid poisoning
- Generally self limited
- Anithistamine PRN
- Epi if severe
