approach to fever

fever

Fever is a symptom, of both infectious and non-infectious diseases, and we need a systematic approach to not miss either, and to resuscitate along the way

A: ABCDEFGHIJKLMN

  • Abscess, Angina Ludwid
  • Bacterial tracheitis
  • Croup
  • Diphtheria
  • Epiglottitis
  • F
  • G
  • H
  • I
  • Johnson
  • Kawasaki
  • L
  • Mono

B: CHEST

  • C
  • H
  • Effusion (malignant, parapneumonic)
  • Sick pneumonia
  • Tumour

C: CARDIOVASCULAR

  • C
  • Around heart: pericarditis, myocarditis
  • RV strain: PE
  • D
  • Incompetent valve: endocarditis
  • O
  • V
  • A
  • S
  • C
  • U
  • Lactate: sepsis, from a variety of causes
  • Adrenal crisis
  • R

D: NEUROLOGIC

  • Encephalitis, meningitis, abscess
  • RBC clot: CVA
  • myeLopathy: epidural abscess

E: ENDO

  • Normothermia: heat stroke
  • hOrmone: hyperthyroid

F: CREATININE, PELVIS

  • uti, pyelo, prostatitis
  • sti, pid

G: ABDOMINAL

  • Ammonia: hepatitis
  • Biliary: cholecystitis, cholangitis
  • Appy, diverticulitis
  • Loose stool: colitis

H: HEME

  • TTP

I: INTOX

  • Ingest: etoh withdrawal
  • Treat: synthroid, SSRI (serotonin syndrome), antipsychotic (NMS), succinylcholine (MH), transfusion reaction
  • OTC salicylates

J: joint, skin, bone

  • septic arthritis, cellulitis, osteomyelitis

 

Putting this together gives a system based approach to infectious and non-infectious sources of fever

  • A: assess lip, tongue, oropharynx and upper airway sources of infectious or inflammation, including urgent need for airway protection antibiotics
  • B: asses and supplement oxygenation, listen and look with ultrasound for effusion/consolidation/mass, consider CXR
  • C: assess HR/BP, read ECG, listen for murmur; fluids/antibiotics for shock, measure CBC/lactate, send blood cultures, consider echo for myocarditis/endocarditis or CT for PE
  • D: assess need for CT head, LP, MRI or spine
  • E: consider thyroid
  • F: examine kidneys/pelvis/prostate, check urinalysis and urine culture
  • G: examine abdomen, measure liver enzymes, consider abdo ultrasound +/- CT
  • H: measure Hgb, Plt, coag
  • I: consider drugs/withdrawal and medications
  • J: examine skin, joints

fever

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