Patient with Fever

Question 1

At what temperature do you start to get concerned?

Answer 1

37.5

Question 2

Temperature measured where is highest - and most accurate?

Answer 2

Rectal

Question 3

In which patient population are rectal temperatures usually taken?

Answer 3

ICU

Question 4

By how much do temperatures vary according to circadian rhythm?

Answer 4

0.5

Question 5

What do the presence of rigors suggest?

Answer 5

Bacterial infection/sepsis

Question 6

What questions should be asked around fever syndromes?

Answer 6

How long has the temperature been there?

What is the pattern of temperature?

Question 7

What is the fever syndrome for malaria?

Answer 7

Temperature cycles over days, differing between species

Question 8

What is the fever syndrome for malaria?

Answer 8

Intermittent fevers

Question 9

What conditions should you think of with fever in a returned traveller?

Answer 9

Malaria
Typhoid
Dengue fever
- Incubation period no more than 2 weeks
Fevers you get as a non-traveller

Question 10

What kind of fever in immunosuppressed patients is serious?

Answer 10

Any fever

May not need to be admitted to hospital, but definitely need to be reviewed

Question 11

What are the risk factors for infection?

Answer 11

Recent surgery = Petersdorf’s law

Travel

Question 12

How do you determine where the infection is?

Answer 12

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

Question 13

Does hypothermia exclude infection?

Answer 13

No, can be significant indicator of infection

Question 14

If a patient is feverish and vomiting, what shouldn’t you miss?

Answer 14

Rash
Neck stiffness and photophobia
Headache
Change in consciousness

Question 15

How long does CRP (and often WCC) take to rise in infection?

Answer 15

24 hours

Question 16

What type of organisms are you particularly susceptible to if you don’t have a spleen?

Answer 16

Capsulated bacteria

Question 17

What does the phrase “don’t let the sun go down on pus” mean?

Answer 17

Drain an abscess promptly

Question 18

What are the questions you need to answer when there’s a Staph aureus bacteraemia?

Answer 18

How did it get in the blood?
- Via skin
Where has it lodged?
- Endocarditis
- Osteomyelitis, vertebral in particular

Question 19

What is the investigation of the heart in endocarditis?

Answer 19

Imaging of heart, preferably trans-oesophageal cardiogram

Question 20

What is the minimum course of antibiotics for Staph aureus bacteraemia?

Answer 20

At least 2 weeks

Question 21

How many sets of blood cultures are preferred in endocarditis?

Answer 21

3

Question 22

What are the symptoms of severe infection?

Answer 22

Rigors
Symptoms <24 hours
Profound effect on patient
Repeated vomiting in absence of diarrhoea
Severe headache
Severe muscle and joint pain

Question 23

What are the signs of severe infection?

Answer 23

RR >24
Systolic BP <100
Pulse >120
T <35.5 or >39
SpO2 <95%
Altered conscious state
Pallor
Mottled skin
Cool peripheries

Question 24

What are the risk factors for severe infection?

Answer 24

Age >65
IVDU
Immunocompromise
Splenectomy
Recent surgery/procedure
Indwelling medical defice
Recent overseas travel
Chronic medical condition
Pregnancy

Question 25

What is the immediate management if there’s evidence of severe infection?

Answer 25

Blood cultures
ABs ASAP
IV fluid resuscitation
Senior review
?ICU support
Other investigations as indicated clinically