temp mgmt

Question 1

heat exhaustion s/s & mgmt

Answer 1

flu-like sx
fever <39
VOLUME DEPLETION W/O HEMODYNAMIC COMPROMISE
no neuro s/s
sweat production

supportive treatment
volume repletion

Question 2

heat stroke s/s & mgmt

Answer 2

life threatening
temp > 41 (106)
severe neuro dysfunction
severe volume depletion w hypotension
multiorgan involvement
minimal sweat production

volume resuscitation
cooling measures
supportive care (rhabdo, acid/base, seizures)
NO role for antipyretics

Question 3

hypothermia diagnostics

Answer 3

ABG - resp/metab acidosis
BMP - hyperkalemia, elevated BUN/Crt
EKG - J waves, T wave inversion, QT prolong, arrhythmias

Question 4

who cannot tolerate fever

Answer 4

cardiac/pulm disease
neuro patients
frailty
older adults
pain/discomfort

fever increases metabolic O2 consumption and caloric requirements

Question 5

common causes of drug fever

Answer 5

amphotericin
cephalosporins
penicillins
phenytoin
procainamide
quinidine

Question 6

top 3 infectious causes of fever

Answer 6

UTI
pneumonia
bloodstream infection

Question 7

specific microbes for fever

Answer 7

ICU - cover gram -

device-related - cover S. aureus

risk populations (recent abx, long hospitalization, immunosuppressed) - consider anti fungal

Question 8

antipyretics

Answer 8

acetaminophen - icu
aspirin
NSAIDS

Question 9

fever of unknown origin

Answer 9

3 weeks duration
fever >38.3 on several occasions
dx after 3 outpatient visits or 3 days inpatient

r/o fictitious fever
most infectious, some neoplasm

no abx unless source
maintain fever log
good history - weight loss?

Question 10

indications for antipyretics

Answer 10

TBI/neurologic insult
limited cardiopulmonary reserve
fever >104

Question 11

management of post-op fever

Answer 11

volume repletion w LR
pulmonary hygiene
mobilization

presumed infection - d/c lines/drains;
empiric abx

surgical site infection will not appear until day 5-7

Question 12

drug induced hyperthermia

Answer 12

malignant hyperthermia (anesthetics, succinylcholine) – muscle rigidity

neuroleptic malignant syndrome (antipsychotics, antiemetics, stimulants, abrupt cessation of DA agonists) –muscle rigidity, AMS

serotonin syndrome (multiple agents)– AMS, hyperreflexia

d/c offending agent!!!!

Question 13

med to treat muscle rigidity

Answer 13

dantrolene

Question 14

hypothermia mgmt

Answer 14

rewarming -

warm blankets
remove wet clothes
increase room temp
O2 humidifier!!!! first line
heated fluids

beware of warming shock w internal rewarming –>v fib

defibrilation requires at least 35 deg farenheight

Question 15

fever definitions

Answer 15

normal adult >38.3
immunocompromised >38
older adult >37.3

Question 16

noninfectious causes of fever

Answer 16

drugs >102, sustained
transfusion rxn
CNS damage (CVA, neoplasm)
fictitious
SIRS, ARDS
volume depletion
post-op
PE/VTE
ETOH/substance withdrawal
MI
autoimmune disease
pancreatitis
fat emboli
gout
hematoma
cirrhosis
phlebitis
GIB, ischemic bowel
decubitus ulcer
thyrotoxicosis, adrenal failure
cholecystitis
iatrogenic

Question 17

noninfectious causes of post-op fever

Answer 17

SIRS!!!!
dehydration
drug/allergic rxn
MI
PE
RP hematoma
solid organ hematoma
intracranial hemorrhage/hematoma
thrombophlebitis
transfusion rxn
withdrawal
acute hepatic necrosis
adrenal insufficnency
NOT ATELECTASIS

infectious - normally subjective complaint (fatigue, swelling, anorexia, leukocytosis w left shift)

surgical site infections 5-7 days post op

Question 18

how to explain fever physiology

Answer 18

fever is the normal normal adaptive response that enhances the body’s ability to eradicate infection

Question 19

drug fever onset

Answer 19

8 days after drug initiation (or longer)

Question 20

other causes of hyperthermia

Answer 20

CNS damage
endocrine
anticholinergic poisoning/overdose
sympathomimetic poisoning/overdose