fever - (My Second Morning Report Steve Anisman The Case 74...

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Morning Report Steve Anisman July 18, 2002 (My Second)
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The Case 74 yo F with large L sided CVA 2 years PTA which had left her unable to meaningfully communicate, and with R sided paralysis. Hx includes a-fib, G-tube for inability to swallow, MRSA 1 year ago. 3 days PTA, she fell out of her wheelchair and “hasn’t been right since.” On day of admission, family called EMT because Pt was oliguric, and unresponsive in bed with blankets on. Family was concerned that Pt may have had another stroke. EMT’s arrive to find Pt as described, with temp 107.6 O F.
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The Case She was transferred to ED, intubated, placed under cooling mist, fans, and given IF fluids. Hospital course remarkable for acute renal failure with eventual resolution, predicted CK curve, and ultimate return to baseline. Remaining issues are focused on disposition, as there is some reluctance to place her back with family secondary to concerns of neglect, and her Hx of MRSA make placement difficult.
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…blah blah blah…
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Hyperthermia Whoops… Instead, let’s talk about
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Fever Definition : Above normal temperature, with set point modification. Normal Temperature: 6:00 < 37.2 o C (98.9 o F) 16:00 < 37.7 o C (99.9 o F) We’re assuming oral readings here, which are expected to be ______________ rectal or tympanic (both “core”) readings. 0.6 o (1.0 o ) below The reason for the discrepancy is evaporative heat loss from mouth breathing, particularly in patients with respiratory disease (and tachypnea).
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Temperature variation Typically, temperature varies about 0.5 o C throughout the day. In fever, this range can double – diurnal variation remains, but at a higher level. Women’s basal temperature drops by ~0.6 o C during the two weeks prior to ovulation – increased temp at ovulation persists until the end of menses. Seasons, pregnancy, digestion all can change set point but not in a reliable way.
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Fever vs. other hotnesses Set point is maintained by the thermoregulatory center in the anterior hypothalamus, and is fixed in early childhood. Control is maintained by increasing heat production in muscle and liver or increasing heat loss through skin and lungs. In fever, the set point becomes elevated. Hyperthermia has nothing to do with metabolic control – the body is simply loaded with heat above its ability to dissipate it. Diurnal variation is not seen with hyperthermia, and antipyretics are ineffectual. Hyperpyrexia is fever > 41.5 o C, typically as a result of CNS hemorrhage, but occasionally with severe infections.
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Why do I feel so… The set point is raised (more details soon), and in order to raise the body temperature to the new level, vasomotor neurons cause vasoconstriction. Vasoconstriction shunts blood to the internal organs, decreasing heat loss from the skin, making extremities feel cold. Shivering is initiated to increase heat production from muscles,
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fever - (My Second Morning Report Steve Anisman The Case 74...

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