This podcast explores the clinical basics of fever, including body temperature measurement techniques and the role of cytokines in triggering fever. It also discusses the evaluation and management of pediatric fever, emphasizing the importance of history and physical examination in determining the cause and the decision-making process for utilizing antipyretics.
Different methods to measure body temperature have varying reliability and considerations, impacting diagnostic decisions.
Fever is a complex physiological response involving cytokines and hypothalamic pathways, guiding clinical evaluation and management.
Deep dives
Approach to Fever Measurement
There are four primary methods to measure body temperature: oral, rectal, axillary, and infrared. While rectal measurements are considered the standard, oral temperatures are influenced by recent liquids and respiratory rates, and axillary measurements are less reliable. Patient discomfort can be a concern with rectal readings, prompting the use of infrared measurements in hospital settings. Fever definitions vary by age group, impacting the threshold for infectious assessment, with different temperature triggers for workups in children under three months versus older age groups.
Pathophysiology of Fever and Evaluation Process
Fever is a physiological response involving hypothalamic pathways that elevate the body temperature set point through mechanisms like increased heat production and decreased dissipation. Cytokines released by phagocytes trigger prostaglandin upregulation, leading to a higher hypothalamic set point. Clinical fever results from the body's adjustments to meet the elevated set point. Evaluation starts with history and physical exams to identify potential sources of fever, with special consideration for infants under 90 days who are at risk for serious bacterial infections, necessitating specific protocols for investigations.
In this video, the viewer will learn the clinical basics of fever as well as the physiology of body temperature and the approach to evaluation and management of fever.
Initial publication: April 9, 2019.
Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children’s Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user.For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu
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