Fever

[BloodNGlory02]

Dispatched to the local skilled nursing facility for a fever. *sigh*

U/A: 32 year old female, hx Huntingtons disease, pt's usually alert but aphasic, started with a fever previous night, MD called, urine cultured, no result yet, pt flailing around more than usual, almost combative like, med list not too extensive, nothing major.

Temperature: 104 auxillary. 105 Tympanic via squad. 2 IVs established, board splinted due to arm flailing, only BP obtainable was around the ankle, 130/68, 163 HR, attempted 15lpm o2 but pt continued to pull it off. ice paks applied to groin and armpits. apprx. 700cc NS infused enroute.

any diagnosis'???

 

[Ridryder911]

Hunnington is a genetic disorder that basically destroys cells at the neuron area. The general "mask" like appearance is common as well as "spastic" movements. Unfortunately, 8 out every 10,000 people may have it and not aware until their mid 30's to 40's.

The fever can be fever of unknown origin (FUO) personally I would retake it using better methods. Axillary is not acceptable and tympanic has been proven to be not reliable for elevated temps. Good old core temp from the nursing staff before I left. Chances are this patient maybe septic from several causes. urine, metabolic, who knows ..? As well, since Huntington's cause cellular retraction at the basilar hypothalamus, it might brain induced malignant hyperthermia.

I would disrobe to cool sheets, Infuse saline in at a moderate rate.. I would not place ice packs... 104- 105 is high but not dangerous enough I would place ice packs.. maybe some saline tepid, bath type of arms, chest... to allow evaporation to occur.

R/r 911

 

[MedicPrincess]

Yep, RR has forgotten more than I can ever dream of knowing, but I am liking sepsis as well.

 

[BloodNGlory02]

Negative on sepsis, and as for the ice paks, the hospital PACKED her in ice on arrival.

 

[Ridryder911]

I bet her temp was higher than 105 then... usual regime is an antipyretic such as Tylenol, etc.. Then cooling pad such as a K-pad. and infusion of Saline. After, the temperature had been monitored > 106-108 (core) some physicians mat induce a drug induced coma such a Barbitual etc... but, everything should be considered first from CBC, CT, LP, cultures, etc.. Most physicians are in agreement, that a high temp is a good thing, it is the body's natural response and indicator that there is problems.... unless, there is associated seizure or cardiac problems.

The reason "ice therapy" has not been in favor for several years, is research has demonstrated it is not beneficial, can produce hypothermia, and frost bite, tissue damage... remember the core is hot, but the this will not reduce the skin from damage.

Curious what the core temp was and the etiology was.. .with Hunnington there could be associated problems.

R/r 911

 

[jeepmedic]

I am thinking something to do with the brain. Although I would still not rule out some type of Sepsis with out labs.

I am betting the core temp. was around 106 or107

 

[trauma1534]

Yep, I am thinking sepsis. You know, when I was going through my training, I was told by my yahoo paramedic instructor that we would not see sepsis that much in the field. That seems to be the majority of what I run into. The HR is showing that they are compensating for something. Although the B/P is still up, I still would like to say it is sepsis. Perhaps the early stages of it.