Fever and hypothermia
Wednesday, May 8, 2024 4:24 PM
fever
The symptoms of the fever:
○ Feeling flushed and warm
○ Sweats
○ Chills
○ Chivering
○ Body aches and headaches
The causes of the fever:
○ Infectious
○ Inflamatory
○ Neoplastic
○ central
The consequences :
○ Infants: febrile seizures
○ Elderly: sever dehydration /system dysfunction cause by
hypermetabolism
Clinical evaluation:
- Search for localising symptoms
- Check if the case is critical
○ Factors related to the patient
○ Signs of acute severe infections
○ Hyperpyrexia
- History taking :
○ History of present complaint
○ If we have a chronic fever , look for:
Night sweats
Weight loss
○ Drug history
Drugs known to cause fever:
- Like antipsychotics as neuroleptic malignant syndrome
- Drug increase risk of infection ( immunosupressants)
- Illicit drug use like cocaine and amphetamine
- Physical examination:
○ Confirmation of fever
○ Other vital signs
Tachycardia/tachypnea /hypotension
○ Patient general appearance
Lethargy
Confusion
Cachexia :
Cachexia is a complex syndrome associated with an
underlying illness, causing ongoing muscle loss that is not
entirely reversed with nutritional supplementation. A
range of diseases can cause cachexia, most
commonly cancer, congestive heart failure, chronic
obstructive pulmonary disease, chronic kidney disease,
and AIDS.
Distress
○ Skin inspection
Petechial :
- Means hemoragic rash+++
Erythema/blistering :
- Soft tissue infecton
○ Explore all nodes areas to look for adenopathy
Neck
Axillae
Epitrochlear
Iinguinal
○ If hospitalised:
Note every iv or catheter or tube inserted into the body.
○ If recent surgery:
Inspect the surgical sides
○ Examine :
Ear:
- Tympanic membrane for infection
Sinuses:
- percuss for dullness
Temporal arteries:
- Palp for tenderness
Nose:
- Congestion and discharge
Eyes:
- Conjunctivitis : yellowish pigmentation of the sclera
- Discharge
Oropharynx and gingiva:
- Inflammation
- Ulceration
Neck :
- U need to flex it to check for stifness
Lungs
- Crackles
- Pleural effusion wich means dullness
Heart :
- Murmur means endocarditis !!
Abdomen :
- Hepatosplenomegaly
- Tenderness : means apendencitis
Flanck:
- Tenderness for pyelonephritis
Pelvic examination:
- Tenderness
All joined need to be examined for :
- Swelling
- Erythema
- Tenderness
Thorough neurological examination:
- Focal deficits
- Red flags :
○ Altered mental status
○ Headache, stiff neck, or both
○ Petechial rash
○ Temperature > 40° C or < 35° C
○ Hypotension
○ Dyspnea
○ Significant tachycardia or tachypnea
○ Recent use of immunosuppressant
○ Recent travel to an area where serious diseases are endemic LIKE
MALARIA
Treatements:
- Treat the cause when identifiable and treatable
- Treat fever itself with antipyretics?
An antipyretic is a substance that reduces fever. Antipyretics cause
the hypothalamus to override a prostaglandin-induced increase in
temperature. The body then works to lower the temperature, which
results in a reduction in fever
Hypothermia:
Causes :
- Primary?
- Secondary:
○ Prolonged exposure to cold
Drawning
Wet clothes etc…
Consequences:
- Slowing metabolism metabolism and all physiological functions
- Vasocontriction to reduce heat loss
Symptoms:
Treatements:
- Prevent further heat loss
- Warm blankets and fluids
- Active rewarming in serious cases
Induced hypothermia:
Induced hypothermia is a technique in which body temperature is
lowered to reduce metabolic rates, oxygen demand, or organ damage. It is
used in various medical scenarios, including:
• Managing stroke and traumatic brain injury
• Alleviating fever or pain
• Improving outcomes in surgery or after cardiac arrest
