<p>Fever</p><p>10/4/11 Examinations Book</p><p>GENERAL APPROACH</p><p>Infectious - community acquired - nosocomial (surgical site, lines, chest, urine, sinusitis)</p><p>Non-infectious - head injury - DVT -> PE - drug/toxin - SIRS (post surgery, trauma, aspiration, pancreatitis) - Hypermetabolic syndromes -> thyroid storm -> NMS -> MH -> heat stroke -> phaeo -> liver failure -> burns -> cocaine toxicity -> serotonin syndrome</p><p>INTRODUCTION</p><p>CUBICLE</p><p>- isolation (MDRO) - long stay patient (new problem -> nosocomial infection)</p><p>INFUSIONS</p><p>- antibiotics (MDRO) - noradrenaline (sepsis) - heparin (DVT -> PE) - blood products (febrile reactions)</p><p>VENTILATOR</p><p>- level of support - level of oxygenation (FiO2, PEEP) - disease specific questions (ARDS: plateau pressure, bronchospasm: dynamic hyperinflation, intrinsic PEEP)</p><p>MONITOR</p><p>Jeremy Fernando (2011) - temperature - tachycardia (SIRS) - ETCO2 (hypermetabolic syndrome) - CVP (number, waveform) - arterial trace (pressure, swing, pulsus paradoxus)</p><p>EQUIPMENT</p><p>- intra-abdominal drains (fluid, amount) - EVD (recent cell count and culture) - rectal tube (diarrhoea) - active cooling (severe hyperthermia) - epidural (inspect site and examine neurology) - intercostals drains (number, bubbling, drainage) - urine (colour, output, myoglobin, microscopy)</p><p>QUESTION SPECIFIC EXAMINATION</p><p>- hands/arms -> head -> chest -> abdo -> legs/feet -> back -> cardiovascular -> respiratory -> abdominal -> haematological</p><p>- neurological -> paralysed -> quick examination -> unconscious -> conscious</p><p>- vaginal examination for retained tampon - age of lines - recent anaesthetics (MH) - recent antibiotic exposure (drug fever)</p><p>RELEVANT INVESTIGATIONS</p><p>- CXR - FBC: WCC - microbiology: sputum, blood cultures, urine, line cultures, intra-abdominal samples - burn biopsy</p><p>OPENING STATEMENT</p><p>=</p><p>My Approach to fever in this patient is to look at Infectious and Non-infectious causes</p><p>I believe that this patient has multiple possible causes for fever:</p><p>List headings of causes -> clinical signs associated with list</p><p>Jeremy Fernando (2011)</p>