Patient with Fever Flashcards
At what temperature do you start to get concerned?
37.5
Temperature measured where is highest - and most accurate?
Rectal
In which patient population are rectal temperatures usually taken?
ICU
By how much do temperatures vary according to circadian rhythm?
0.5
What do the presence of rigors suggest?
Bacterial infection/sepsis
What questions should be asked around fever syndromes?
How long has the temperature been there?
What is the pattern of temperature?
What is the fever syndrome for malaria?
Temperature cycles over days, differing between species
What is the fever syndrome for malaria?
Intermittent fevers
What conditions should you think of with fever in a returned traveller?
Malaria Typhoid Dengue fever - Incubation period no more than 2 weeks Fevers you get as a non-traveller
What kind of fever in immunosuppressed patients is serious?
Any fever
May not need to be admitted to hospital, but definitely need to be reviewed
What are the risk factors for infection?
Recent surgery = Petersdorf’s law
Travel
How do you determine where the infection is?
Localising symptoms
- Duration and rate of evolution of symptoms
- Pain
- Pain/fever can be absent in elderly
Watch for common false-localising symptoms; eg: diarrhoea - sepsis very common cause
Does hypothermia exclude infection?
No, can be significant indicator of infection
If a patient is feverish and vomiting, what shouldn’t you miss?
Rash
Neck stiffness and photophobia
Headache
Change in consciousness
How long does CRP (and often WCC) take to rise in infection?
24 hours
What type of organisms are you particularly susceptible to if you don’t have a spleen?
Capsulated bacteria
What does the phrase “don’t let the sun go down on pus” mean?
Drain an abscess promptly
What are the questions you need to answer when there’s a Staph aureus bacteraemia?
How did it get in the blood? - Via skin Where has it lodged? - Endocarditis - Osteomyelitis, vertebral in particular
What is the investigation of the heart in endocarditis?
Imaging of heart, preferably trans-oesophageal cardiogram
What is the minimum course of antibiotics for Staph aureus bacteraemia?
At least 2 weeks
How many sets of blood cultures are preferred in endocarditis?
3
What are the symptoms of severe infection?
Rigors Symptoms <24 hours Profound effect on patient Repeated vomiting in absence of diarrhoea Severe headache Severe muscle and joint pain
What are the signs of severe infection?
RR >24 Systolic BP <100 Pulse >120 T <35.5 or >39 SpO2 <95% Altered conscious state Pallor Mottled skin Cool peripheries
What are the risk factors for severe infection?
Age >65 IVDU Immunocompromise Splenectomy Recent surgery/procedure Indwelling medical defice Recent overseas travel Chronic medical condition Pregnancy
What is the immediate management if there’s evidence of severe infection?
Blood cultures ABs ASAP IV fluid resuscitation Senior review ?ICU support Other investigations as indicated clinically
