CanadiEM Podcasts: CRACKCast, ClerkCast, CarmsCast, First Year Diaries CRACKCast E012 - Fever
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Mar 14, 2016 A focused dive into fever physiology and how prostaglandins and the hypothalamic set-point drive temperature changes. Practical vitals rules: how heart and respiratory rates change per 1°C. A structured emergency approach to infectious causes and high-risk infections you must not miss. Clear contrasts between fever and hyperthermia and a rundown of non-infectious causes and accurate core temperature measurement.
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Vitals Change Predictably With Fever
- Expect heart rate to rise 10–20 beats per minute and respiratory rate to rise 2–4 breaths per minute for every 1°C increase in core temperature.
- Watch for relative bradycardia which can be a clinical clue despite the expected tachycardic response.
Triage Fever By Organ System Focusing On Do Not Misss
- Approach febrile patients by organ system and prioritize critical 'must-not-miss' diagnoses first.
- Immediately consider bacterial pneumonia, peritonitis, meningitis, cavernous sinus thrombosis, sepsis, and meningococcemia as top critical causes.
Identify Emergent Sources That Need Rapid Workup
- For emergent but not immediate resuscitation causes, consider peritonsillar/retropharyngeal abscess, epiglottitis, endocarditis, pericarditis, appendicitis and intra-abdominal sepsis.
- Inspect airway threats and severely painful GU/GI presentations that usually need ED workup.