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My Heart is Racing! Select Cardiac Arrhythmias and Practice Updates

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sábado, 17 de diciembre de 2016

Fever in the ED

emDocs - December 16, 2016 - 
Authors: Dewitt S, Tech-Carilion V, Chavez S and Perkins J Edited by: Koyfman A and Long B

"Takeaways:
  • Not all fever is from an infectious source. Keep a broad differential and narrow based on a detailed history, a thorough physical exam, and lab/imaging results.
  • Blood cultures are not a routine part of the evaluation of fever and should be deployed in clinical scenarios which are evidence-based (e.g. septic shock) or when the results would affect patient care.
  • CRP, PCT, and ESR can be helpful in certain patient care scenarios as adjunctive information when trying to establish the source of a fever as infectious in etiology. Lack of specificity for each of these makes the clinical pre-test probability paramount prior to ordering these tests.
  • Not all septic patients have fever! Those without fever have been shown to have worse in-hospital outcomes.
  • Oral temperatures can be used for clinical decision making if a fever is documented. However, the poor sensitivity of oral temperatures mandates that a core temperature be obtained if the result would change management. Bottom line: if you suspect sepsis and the patient is afebrile orally, get a core temperature.
  • Use your clinical judgment when deciding whether to treat a fever—not all fevers need to be treated with anti-pyretics.
  • Do not dismiss the diagnosis of pulmonary embolus because the patient is febrile."