From WardWiki - Foundation Doctor Helper
Pyrexia is, by definition, a temperature above 37.5 degrees Celcius. Hypyrexia above 41.5 degrees Celsius is rare but extremely dangerous and requires senior support immediately. Sepsis, intracerebral events, malignant hyperthermia from anaesthetic gases and reactions to psychotropic medications can cause this but these are much rarer than sepsis. Temperature may be taken orally, axillary or from the aural tympanum; rectal, although accurate, is seldom used on wards. Isolated points on an early warning system chart can be deceiving; always just the points and the pattern is much more apparent.
Autoimmune or reactive inflammation
Malignancies including haemoproliferative disorders
Order of Fever
Postoperative pyrexia is common and the causes myriad. The following list is useful when considering the causes;
Post operative inflammatory reaction; much rarer is a castrophic contimination of the body cavity, such as from anastomotic failure or inadequate toilet post contamination. Be very wary of dismissing Day 1 pyrexia when SIRS is evident.
Atelectasis. Also any day 1 cause
The three C's: Catheter, peripheral Cannula and Central line. UTI's are rare before Day 3. Also any day 2 cause.
Pneumonia, wound infection (may lead later to a burst abdomen). Also any day 3 cause
Deep vein thrombosis or pulmonary embolism. Anastomotic leak ( more common Day6 - 10). Also any Day 4 cause.
After day 5 all causes must be searched for with a septic screen and more crucially, as it is so often missed, a full inspection of the patient; palpation of the abdomen; percussion of the chest, and auscultation of both.
Make no attempt to look through notes and charts before seeing a patient. The Ccrisp course algorithm clearly states that charts and notes are reviewed after an initial assessment of the patient.
Lowering pyrexia below 41.5 degrees Celsius will comfort the patient and reduced water loss from perspiration but it's therapeutic utility is unproven. Certainly pyrexia is not treated solely with antipyrexial medications and simple observation; the cause must be carefully elicited, with blood cultures taken if no obvious cause is found. Night duty is a prime opportunity for a doctor to to slacken and attempt to handle a pyrexia with by a telemedicine prescription of paracetamol. Pyrexia of unknown origin is a label that may only be given by a consultant; for anyone lower it is an expression only of one's own lack of will, initiative and thoroughness in investigation.