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EM - Exam 2 > Fever > Flashcards

Fever Flashcards

1
Q

What temperature is considered a fever?

A

Greater than 100.4 F

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2
Q

How much can a healthy person’s temperature vary throughout the day?

A

As much as 3.6 F

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3
Q

When is body temperature the lowest? When is it the highest?

A

Lowest at 6:00am

Highest at 6:00pm

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4
Q

What method of obtaining body temp is the most accurate?

A

Rectal

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5
Q

What is the accuracy of oral temperature taking?

A

Usually underestimates by approx 0.4 degrees F

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6
Q

What method of obtaining body temp is least accurate?

A

Axillary/temporal

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7
Q

Define malignant hyperthermia

A
  • Hypermetabolism involving skeletal muscle

- Triggered by inhaled anesthetics or succinylcholine

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8
Q

Post-op causes of fever

A
  • 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)
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9
Q

What is most likely cause of fever 1-2 days post op?

A

Inflammatory 2/2 trauma or stress (WIND)

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10
Q

What is most likely cause of fever 3-5 days post op?

A

UTIs (WATER)

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11
Q

What is most likely cause of fever 4-6 days post op?

A

Cellulitis, abscess (WOUND)

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12
Q

What is most likely cause of fever 5-7 days post op?

A

DVT, thrombophlebitis (WALKING)

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13
Q

What is most likely cause of fever 7+ days post op?

A

Drug reaction or OBGYN infection (WONDER Drugs or WOMB)

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14
Q

For every 1 degree F increase, how much does HR change?

A

Increased by 10 bpm

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15
Q

How is metabolism affected by increase in body temp?

A

Increases 7% for each 1 degree increase

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16
Q

How does fever affect immune function?

A

Fever enhances immune function and may act protectively

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17
Q

Body temp over 106 degrees F may lead to what?

A

ICB
Rhabdo
Organ damage

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18
Q

Define delirium

A

Fluctuating disorder of consciousness

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19
Q

Define left shift

A

Increased production of immature WBCs (aka bandemia)

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20
Q

What does absolute neutrophil count determine?

A

Degree of immunocompromise in chemo

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21
Q

When is lactic acid elevated?

A

When body breaks down carbs to use for energy during times of low oxygen levels (e.g. sepsis)

22
Q

When should acetaminophen be avoided?

A

Liver failure

23
Q

When should ibuprofen be avoided?

A 
Gastric ulcer
(dose reduce in renal failure)
24
Q

Define fever of unknown origin

A

Fever for over 3 wks with no identified cause after 3 days of hospital eval OR 3 outpatient visits

25
Q

Etiology of fever of unknown origin

A

Infections (25-50%)
CT disorders (10-20%)
Neoplasms (5-35%)

26
Q

Define distributive shock

A
  • Hypotension resulting in compromised end-organ oxygenation

- 2/2 decreased vascular resistance (despite normal circulatory volume)

27
Q

Define systemic inflammatory response syndrome (SIRS)

A

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
28
Q

Define sepsis

A

SIRS due to documented or suspected infection

29
Q

Define severe sepsis

A
  • Septic shock

- Sepsis plus evidence of acute organ dysfunction or tissue hypoperfusion

30
Q

Mortality rate of sepsis?

A

Declining but the incidence of sepsis is increasing which results in more annual deaths

31
Q

Community acquired etiologies of sepsis

A
  • PNA
  • UTI
  • ABD/GYN source
  • Skin cellulitis/abscess
  • Meningitis
  • Endocarditis (IVDA)
32
Q

Hospital acquired etiologies of sepsis

A
  • IVs/Foleys
  • Intubation
  • Ulcers/wounds
  • Surgery/procedures
  • ICU admission
33
Q

Etiologies of non-bacterial SIRS

A
  • Pancreatitis
  • PE
  • Burns
  • Fungal
  • Viral (flu, CMV)
  • Autoimmune (SLE)
  • Anaphylaxis
34
Q

What is RUSH in regards to sepsis?

A

Rapid Ultrasound for Shock and Hypotension

35
Q

Sepsis metrics to be completed within 3 hours

A
  • Lactate level
  • Blood cultures
  • Broad spectrum abx
  • Saline
  • O2
36
Q

Sepsis metrics to be completed within 6 hours

A

CENTRAL LINE

  • Vasopressors to maintain MAP over 65
  • ScvO2 measurement
  • Recheck lactate
  • CVP measurement if possible
37
Q

Goals of sepsis metrics

A
  • MAP over 65
  • Urine output over 0.5 mL/kg/hr
  • ScvO2 over 70%
  • Normal lactate
38
Q

Empiric abx for sepsis treatment

A

Ceftriaxone plus Vancomycin

39
Q

What is CURB-65?

A

Pneumonia severity scoring

  • Confusion
  • Urea over 20
  • Resp rate over 30
  • Blood pressure (SBP under 90 or DBP under 60)
  • Age 65+
40
Q

Define fixed drug eruption

A
  • 1 or more annular erythematous patches

- Normally resolve w/hyperpigmentation and may recur at same site with re-exposure to the drug

41
Q

Define urticaria

A
  • Hives
  • Vascular reaction of skin marked by smooth, slightly elevated wheals
  • Pruritus
42
Q

Define angioedema

A

-Swelling of deep dermis, SQ or submucosal tissue due to vascular leakage
-Tongue, lips, periorbital
(GI or pulm possible)

43
Q

Define anaphylaxis

A
  • Shock state secondary to allergen trigger

- Results in hypotension, bronchospasm, GI/uterine contraction, urticaria/angioedema

44
Q

Describe exercise induced allergic reaction

A
  • Exercise triggers food allergy within 1-4 hrs of eating

- MC wheat, corn, garlic, veggies, shellfish

45
Q

How to treat mild allergic reaction

A
  • Monitor and IV access
  • Benadryl
  • Steroids
  • H2 blocker
46
Q

How to treat severe allergic reactions

A
  • 2 IVs, benadryl, steroids, H2 blocker
  • Epi
  • Albuterol
  • Vasopressors, glucagon, intubation may be necessary
47
Q

Treatment of ACE induced angioedema?

A
  • NOT responsive to traditional allergic treatment

- FFP 2-4 units IV

48
Q

Define scombroid poisoning

A
  • Improper fish storage

- High levels of histidine in flesh converted to histamine (heat resistant, cooking will not affect it)

49
Q

Onset of scombroid poisoning

A

Few mins to hours from consumption of fish

50
Q

Clinical presentation of scombroid poisoning

A
  • Rash and flushing of face/upper body resembling a sunburn
  • Diarrhea, vomiting
  • Palpitations, sweating, HA
  • Burning or swelling of mouth
  • Metallic taste
51
Q

Treatment of scombroid poisoning

A
  • Generally self limited
  • Anithistamine PRN
  • Epi if severe

EM - Exam 2 (7 decks)

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