APPROACH TO FEVER AND SEPSIS

DEFINITIONS
• Fever : increase in the body core temperature

• Sepsis : temperature >38 or <36 , HR >90 , RR

>20 , TWC >12 (at least 2 of the above)

• Septic shock : sepsis with hypotension despite

adequate fluid resuscitiation
 ETIOLOGY
• Many disorders can cause fever. They are
broadly catergorized as :
– Infectious
– Neoplastic
– Inflammatory
 CAUSES
• NONE
– URTI / LRTI
– GI infection
– UTI
– Skin infection
• TRAVEL
– Malaria
– Dengue fever
– Diarrheal disorders
• HOSPITALIZATION
– IV catheter infection
– UTI (particularly in patients with catheter)
– Pneumonia
– DVT / PE
– Hematoma
– Transfusion reaction
• VECTOR EXPOSURE
– Dengue
– Leptospirosis
– Rabies
– Cat scratch disease
• IMMUNOCOMPRONISED
– VIRUS : CMV infection
– PARASITES : Toxoplasmosis infection
• DRUGS
– Antipsychotics
– Anesthetics
– Phenytoin
 TYPES OF FEVER
• Step ladder fever
• Fever with chill and rigor
• Intermittent fever
• Continuous fever
• Remittent fever
 HISTORY TAKING
• HOPI
– Duration of fever
– Character of fever
– Associating factors : chills / rigors, rashes, pain
• PMH
– Underlying diseases
– Recent surgery
• DRUG
– Corticosteroids, chemotherapeutic drugs
– Illicit drug useage
 PHYSICAL EXAMINATION
• GENERAL APPERRANCES :
– Weakness, lethargy, confusion, cachexic, distress
• RASHES
• LYMPHADENOPATHY
• SURGICAL SITES
• LUNGS
• CVS
• P/A
• CNS
 RED FLAGS
• Altered mental status
• Headache, neck stiffness
• Hypotension
• Tachycardia / tachypnea
 INVESTIGATION
• FBC
• Blood cultures
• UFEME
• Urine culture
• Chest xray
 TREATMENT
• Symptomatic treatment
• Heamodynamic stabilization