Fever

 Differential

1. Fever Differential is broad: 
- Infection (lung, heart, brain, urine, sinuses, prostate, abdomen, skin, joints, lines, etc)  
- Infammation (Collagen vascular disorder, neoplastic disorder)  
- Mucositis
- Atelectasis
- Blood product reaction
- Drug fever (beta lactam antibiotics and amphotericin common causes)
- PE vs DVT DVT 

2. Is it a true temperature?

-   Is it greater than >100.4 F?
- Quickly chart check and determine if patient is stable vs unstable (look at vitals, etc).   If unstable go to bedside immediately!  

3.  If unstable:
-

First:   Brief yet thorough chart check
-

 Go assess bedside.

Get as much hx as you can - drug allergies, recent infections, blood transfusions, etc. Targeted exam (skin, lungs, extremities, etc). If patient is not responsive or sudden change in mentation, address those first.    
- If you have an idea where the infection is coming from, start targeted antibiotics.     
- If no idea where infection is coming from,   repeat blood culture if > 48 hours since last blood culture. If blood culture performed less than 48 hours ago, usually no need to repeat blood culture.
-Consider pan culture - UA, Urine Clx, line clx, CXR, and EKG on top of repeat blood cultures.  
- Labs to order (based on presentation/suspicion): CBC, CMP, Lactate, Trop, BNP, D-dimer, PT/PTT, etc.
- Also start broad-spectrum antibiotics (Vancomycin/Zosyn) (unless antibiotic allergies)
- ICU consult, Stat.  

4. If stable:

- Assess where the nurse took temperature, is it in the correct location?
- Have RN recheck temperature in 30 mins and dochalo/ call you. You do not have to act on one temperature, first confirm it. (Exceptions might be if the patient is neutropenic, then consider neutropenic fever).  
- Do a thorough chart check while you wait for a call back:
                - Why was the patient admitted?
                - What was the WBC?
                - What was the urine output?
                - Any recent meds/blood transfusions/surguries?
- If after 30 minutes temperature is confirmed, go assess patient bedside.  
- Get a detailed history from patient.  
- Do a thorough PE, looking for skin infections (including decubitus ulcers), and looking at all lines.  
- If worried about an infectious cause, start appropriate antibiotics.  

5. Special considerations: