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    Fever: MR Suneil Ramnani Consultant in Emergency Medicine Princess Alexandra Hospital

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    Fatihd
    This document defines fever and discusses its causes, assessment, investigations, management, and red flags. It notes that fever is a common complaint seen in both adult and pediatric emergency department attendances. While most fevers are caused by self-limiting viral infections, fever can sometimes indicate serious or life-threatening illness. A thorough history and physical examination are key to determining the cause and appropriate management of fever.

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    Fever: MR Suneil Ramnani Consultant in Emergency Medicine Princess Alexandra Hospital

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    Fatihd
    30 views14 pages
    This document defines fever and discusses its causes, assessment, investigations, management, and red flags. It notes that fever is a common complaint seen in both adult and pediatric emergency department attendances. While most fevers are caused by self-limiting viral infections, fever can sometimes indicate serious or life-threatening illness. A thorough history and physical examination are key to determining the cause and appropriate management of fever.

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    This document defines fever and discusses its causes, assessment, investigations, management, and red flags. It notes that fever is a common complaint seen in both adult and pediatric emergency department attendances. While most fevers are caused by self-limiting viral infections, fever can sometimes indicate serious or life-threatening illness. A thorough history and physical examination are key to determining the cause and appropriate management of fever.

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    30 views14 pages

    Fever: MR Suneil Ramnani Consultant in Emergency Medicine Princess Alexandra Hospital

    Uploaded by

    Fatihd
    This document defines fever and discusses its causes, assessment, investigations, management, and red flags. It notes that fever is a common complaint seen in both adult and pediatric emergency department attendances. While most fevers are caused by self-limiting viral infections, fever can sometimes indicate serious or life-threatening illness. A thorough history and physical examination are key to determining the cause and appropriate management of fever.

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    of 14

    FEVER

    MR SUNEIL RAMNANI
    CONSULTANT IN EMERGENCY MEDICINE
    PRINCESS ALEXANDRA HOSPITAL
    OBJECTIVES

     Define Fever
     Discuss Causes
     Assessment
     Investigations
     Management
     Red Flags and Pitfalls
     Summary
    WHAT IS FEVER?

     ‘A temporary increase in the core body


    temperature above the normal range caused by
    elevation of the hypothalamic set point’
     No single agreed upper limit for normal
    temperature.
     Normal core body temperature in healthy people
    is 35.6˚c – 38.2˚c (mean 36.8˚c)
     In adults, a temperature of 38.3˚c is a fever.
     In infants, a rectal temperature of 38˚c is a fever.
     A temperature over 41.5˚c is not a true fever.
    FEVER FACTS
     Common complaint – 6% of adult ED attendances
    and 20-40% of paediatric attendances.
     Same as Pyrexia!
     Rectal temperature is most accurate measurement.
     Generally a response to disease or illness but can be
    ‘physiological’.
     Can indicate serious or life threatening illness.
     No relationship between magnitude of temperature
    and severity of illness.
    FEVER-CAUSES

     Hundreds!
     Mostly caused by self limiting viral infections.
     Infections are the most common cause (acutely!).
    30-40%
     Cause usually apparent in ED. (pneumonia, UTI
    etc)
     FUO/PUO (fever >38.3˚c documented on several
    occasions during a period of more than 3 weeks
    with uncertain diagnosis after 1 week of
    evaluation in hospital).
    FEVER OF UNKNOWN ORIGIN (FUO)

     Infections/Infectious diseases 20-40%


     Neoplastic/Malignancy 10-30%
     Non-infectious Inflammatory diseases (eg
    collagen vascular diseases, connective tissue
    diseases) 20-35%
     Miscellaneous (including drug fever) 10-20%
     No diagnosis 20-30%
    ASSESSMENT: HISTORY
     Key to Assessment
     Associated Symptoms: Cough, SOB, pain, dysuria, diarrhoea,
    weight loss, sweats, rigors, fever, rash, lumps/itching.
     Duration
     Ill contacts, pets, animal contacts
     Occupation
     Travel history
     Medication
     History/risk of immunocompromise
     Sexual History, IVDU
     Bites, Cuts, Surgery
    ASSESSMENT: EXAMINATION

     General appearance: sick Vs well


     Vital signs
     Subtle mental state changes
     Rashes
     Skin, eyes, lymph nodes, throat, teeth
     Liver and spleen
     Occult sites of infection: nose/sinuses
     PR exam (prostatitis, perirectal abscesses)
     Pelvic exam
     Nails, joints, temporal arteries
    INVESTIGATONS
     Guided by history and examination.
     No tests that are always needed for every patient.
     Clinical judgement required.
     Consider:
     Bloods:
    ▪ FBC and differential. Blood film.
    ▪ Renal profile
    ▪ LFTs
    ▪ CRP, ESR
    ▪ VBG
     Urine dip
     Cultures – urine, sputum, blood, stool.
     ECG
     CXR
     Thick and thin blood films.
    INVESTIGATIONS 2

     Other tests for the medics!


     Serology/virology (EBV,CMV,HIV),
    Rheumatoid factor, ANA, protein
    electrophoresis, Mantoux, CT scans,
    LP,ECHO.
    FEVER RED FLAGS

     Systemic upset/symptoms
     ‘Unwell’
     Abnormal vitals
     Abnormal bloods/investigations (eg CRP,
    WBC, lactate)
     Immunocompromised
     Admit/refer the above
    FEVER - MANAGEMENT

     Depends on the cause


     Resuscitate!
     Antipyretics?
     Antibiotics?
     Admission/Followup?
    SUMMARY

     Relatively common presentation.


     Many causes (not just infections!)
     May be serious (but usually not!)
     History and examination are paramount
     Treat the cause
     Admit the ill!
     Arrange followup for FUOs
    QUESTIONS?

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