Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e
Chapter 113. Fever and Serious Bacterial Illness
Sections: Fever, Serious Bacterial Illness, General Treatment and Disposition Principles Based Upon Age, Fever Evaluation in Neonates and Infants 3 Months of Age, Infants 3 to 36 Months Old, Fever in Children >36 Months of Age, Acknowledgment, References.
Topics Discussed: bacteremia; fever; fever of the newborn.
Excerpt:"Fever is the most common chief complaint of children presenting
to the ED, and accounts for approximately 30% of pediatric
outpatient visits. Emergency providers evaluating febrile children
must differentiate mildly ill from seriously ill children, a challenge
that may be compounded when nonspecific symptoms or no focus of
infection are apparent, especially in the neonate and infant. The
extent of the diagnostic workup and the initiation of appropriate
management must be determined. Many factors, such as clinical assessment,
physical examination findings, age of the patient, immunization
status, and height of the fever, influence evaluation and management
decisions.Fever is defined as a
rise in core body temperature associated with a resetting of the
body's thermostat. This thermostat is located in the preoptic
region of the anterior hypothalamus. Exogenous fever-producing substances
(pyrogens), such as bacteria, bacterial endotoxin, antigen-antibody
complexes, yeast, viruses, and etiocholanolone, may stimulate the formation
and release of endogenous pyrogens. Endogenous pyrogens are produced
by neutrophils, monocytes, hepatic Kupffer cells, splenic sinusoidal
cells, alveolar macrophages, and peritoneal lining cells, and are..."
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