Fever : Medical Triage : Online Medical Help

Medical Triage : Online Medical Help
Fever

 There are many immediately life-threatening causes and serious causes of fever.

Most causes are infective.

Non-infective causes include malignancy, connective tissue disease, strokes, heat stroke and drugs.

Fever

Subjective          

A few symptoms may

be, but are not always,

associated with

potentially life

threatening causes of fever: 

rash, abdominal pain, breathlessness and severe headache.

Fever

                 

A few directed questions may reveal the source of fever:           

1.cough, running nose or sore throat, breathlessness and chest pain.

2.vomitting, abdominal pain, diarrhea.  

3.frequency and dysuria              

4.vaginal discharge in women of     reproductive age.

Fever

Some screening questions are important:

n  Past history of febrile fits in children

n  Last menstrual period in women of reproductive age.          

n  Past history of malaria in foreign worker              

n  Duration of fever

n  Fever

Objective           

Most patients have tachycardia not useful vital for triage purposes.

Hypotension in septic shock. These patients should be classified as critical.

Toxic, restless, dehydrated or drowsy patient should be seen early.

 Look out for a rash, pallor and jaundice.

Fever

Critical

Patients with hypotension

Patients who are restless or drowsy.     

Patients who are also tachypneic.

Patient with severe headache and/or severe nausea and vomitting.

Semi-critical

Patients who are lethargic and unable to walk   

Non-critical      

Comfortable-looking patients with fever

Fever

Plan

Diagnostic tests

Non-toxic, normotensive and alert patient with urinary symptom urine dipstix and FEME can be collected.

Consider Chest Xray for patients with cough more than a week.

Treatment

Children with fever more than 38.5°C should be sponged down.

Abdominal Pain

                Immediately life-threatening causes of abdominal pain

                 

Ruptured/leaking abdominal aortic aneurysm.

Ruptured organs and viscera eg splenic rupture, liver rupture by tumor, perforated peptic ulcer.

Perforated intestinal obstruction, ectopic pregnancy.    

Abdominal Pain

Serious causes of abdominal pain:-

intra abdominal sepsis - appendicitis, peritonitis, cholangitis, cholecystitis

Pancreatitis

Acute pyelonephritis

Other causes:

Obstructed hollow viscus (bilary colic, intestinal obstruction, and ureteric colic)

Metabolic conditions (diabetic ketoacidosis, porphyria)

Neurogenic (eg herpes zoster).