Fever is defined as a temperature higher than 37.5 ° C axillary and 38 ° C rectally.
It is usual to consider that taking axillary temperature underestimates 0.5 ° C core temperature but this is very approximate.
Use an electronic thermometer if possible (The temperature must be taken for 5 minutes when using a mercury thermometer).
Fever is often linked, but not exclusively, to an infectious state.
All clinical examination must do research.
In a febrile patient, look first signs of severity and then try to make a diagnosis.
Signs of severity:
– Signs of sepsis associated with signs of shock circulatory or respiratory failure, purpura, confusion, coma.
– Signs related to the achievement of a device: meningeal syndrome, seizures, heart murmur on auscultation, abdominal pain, skin lesions, etc.
– Patient Plot: malnutrition, immunosuppression, splenectomy, chronic illness, extreme ages of life, patient bedridden.
Etiologies:
Many diseases, infectious or not, acute or chronic, benign or malignant accompanied by fever. Among infectious diseases requiring urgent treatment should be sought:
– Purpura fulminans
– Bacterial meningitis
– Severe malaria
– Severe bacterial skin infection
– Acute pyelonephritis with urinary retention
– Peritonitis or gastrointestinal infection
– Pneumonia with respiratory distress
– Laryngitis subglottic or epiglottitis
– Endocarditis
– Septicemia
With no sign of seriousness and obvious diagnosis, the patient can be sent home with a prescription for antipyretic, prevention tips (plenty of fluids) and surveillance (for signs requiring renewed consultation).
The situation should be reassessed no later than 48 hours after the first consultation if the clinical condition does not improve or before it worsened.
When in doubt (p. Ex. On evolution, quality monitoring) and depending on the context (geographical distance, transport difficulties), it may be necessary to keep the patient under observation for 12 to 24 hours.
Complications:
– Convulsions
– Dehydration
– Confusion, delirium
– Shock
It is important, especially in infants, to look for and treat, but especially to prevent them.
Symptomatic treatment:
– Discover the patient; wrap the child in a damp cloth or give a bath at 37 ° C for several minutes.
– Antipyretics:
paracetamol PO
Children: 60 mg / kg / day divided into 3 or 4 doses
Adult: 3-4 g / day divided into 3 or 4 doses
or
acetylsalicylic acid (ASA) PO (to be avoided in children under 16 years)
Adult: 1 to 3 g / day divided into 3 or 4 doses
or
ibuprofen PO
Children over 3 months: 30 mg / kg / day in 3 doses
Adult: from 1200 to 1800 mg / day divided into 3 or 4 doses
– Although hydrate the patient.
– Continue feeding / breastfeeding even if the child has little appetite. We must convince the mother.
– In case of febrile seizures, see page 24.
– Treatment of the cause of fever as the etiological diagnosis
remarks:
– Paracetamol is the drug of choice in pregnancy or breastfeeding.
– Aspirin is not recommended during the first 5 months of pregnancy, against-indicated from the 6th month and to avoid breast-feeding women.
– Ibuprofen is not recommended during the first 5 months of pregnancy and contraindicated from the 6th month. It can be administered for a short period, in lactating women.
