History:

 

• Age
• Duration of fever
• Severity of fever
• Past medical history
• Medications
• Immunocompromised
  • Transplant
  • HIV
  • Diabetes
  • Cancer
  • Sickle Cell Disease
  • < 60 days old
• Environmental exposure
• Last Acetaminophen or Ibuprofen

 

Significant Findings:

 

• Warm
• Flushed
• Sweaty
• Chills/rigors

 

Associated Symptoms (Helpful to localize source)

 

• Myalgia
• Chest pain
• Cough
• Headache
• Dysuria
• Mental status changes
• Rash

 

Differential:

 

• Infections/sepsis
• Cancer/tumors/lymphomas
• Medication/drug reaction
• Connective tissue disease
• Arthritis
• Vasculitis
• Hyperthyroidism
• Heat stroke
• Meningitis

 

Contact, droplet, and airborne precautions

 

Treatment:

 

• Orthostatic blood pressure

• Oxygen

• Measure temperature

• Initiate IV

• Consider Normal Saline 20 mL/kg IV; max 60 mL/kg or 1,000 mL

 

Temperature >100.4⁰F (38 ⁰C); if awake and no risk for aspiration ?

 

• Yes

 

• • Acetaminophen (Tylenol) 15 mg/kg PO (EMT)

 

• No

 

• • Notify receiving facility or contact Medical Control

 

PEARLS:

 

• Pediatric =

• • 1 day to less than age 12, or
  • less than 55 kg in ages 12-18.

• Use Handtevy for pediatric drug dosages.
• Acetaminophen quick calculation:
  • Weight in kg/2 = dose in mL.
• Febrile seizures are more likely in children with a history of febrile seizures and with a rapid elevation in temperature.
• Patients with a history of liver failure should not receive Acetaminophen (Tylenol).
• Droplet precautions include:
  • standard PPE

• • standard surgical mask for providers who accompany patients in the back of the ambulance
  • surgical mask or non-rebreather O2 mask for the patient.
• This level of precaution should be utilized when:
  • influenza
  • meningitis
  • mumps
  • streptococcal pharyngitis
  • and other illnesses spread via large particle droplets are suspected.
• A patient with a potentially infectious rash should be treated with droplet precautions.

• Airborne precautions include:
  • standard PPE
  • utilization of a gown
  • change of gloves after every patient contact
  • strict hand washing precautions
• This level of precaution should be utilized when:
  • multi-drug resistant organisms
    • (i.e., MRSA)
    • scabies
    • zoster (shingles)
    • or other illnesses spread by contact are suspected.
• All-hazards precautions include:
  • standard PPE
  • airborne precautions
  • contact precautions
• This level of precaution is utilized during:
  •  the initial phases of an outbreak
  • when the etiology of the infection is unknown or
  • when the causative agent is found to be highly contagious (i.e., SARS).
• Rehydration with fluids increases the patients ability to sweat and improves heat loss.
• All patients should have drug allergies documented prior to administering pain medications.
• NSAID's should not be used in the setting of environmental heat emergencies.