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    ΕΜΠΥΡΕΤΟ EKPA

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    Elena
    This document discusses the management of a patient presenting with fever. It describes the case of a 30-year-old man with a 3-day fever and sore throat. On examination, he has enlarged tonsils with white exudate. Laboratory tests and imaging show signs of infection. He is diagnosed with streptococcal pharyngitis and treated with antibiotics, antipyretics, and rest. Complications of fever are also outlined.

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    ΕΜΠΥΡΕΤΟ EKPA

    Uploaded by

    Elena
    31 views25 pages
    This document discusses the management of a patient presenting with fever. It describes the case of a 30-year-old man with a 3-day fever and sore throat. On examination, he has enlarged tonsils with white exudate. Laboratory tests and imaging show signs of infection. He is diagnosed with streptococcal pharyngitis and treated with antibiotics, antipyretics, and rest. Complications of fever are also outlined.

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    ΕΜΠΥΡΕΤΟ-EKPA

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    This document discusses the management of a patient presenting with fever. It describes the case of a 30-year-old man with a 3-day fever and sore throat. On examination, he has enlarged tonsils with white exudate. Laboratory tests and imaging show signs of infection. He is diagnosed with streptococcal pharyngitis and treated with antibiotics, antipyretics, and rest. Complications of fever are also outlined.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    31 views25 pages

    ΕΜΠΥΡΕΤΟ EKPA

    Uploaded by

    Elena
    This document discusses the management of a patient presenting with fever. It describes the case of a 30-year-old man with a 3-day fever and sore throat. On examination, he has enlarged tonsils with white exudate. Laboratory tests and imaging show signs of infection. He is diagnosed with streptococcal pharyngitis and treated with antibiotics, antipyretics, and rest. Complications of fever are also outlined.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 25

    ΔΙΑΧΕΙΡΙΣΗ ΑΣΘΕΝΟΥΣ ΜΕ

    ΕΜΠΥΡΕΤΟ

    ΙΑΝΚΟΥ ΚΛΑΟΥΝΤΙΑ
    Παθολόγος Επιμελήτρια Α’
    Πανεπιστημιακή Κλινική Επειγόντων Περιστατικών
    ΠΓΝ ΑΤΤΙΚΟΝ
    EPIDEMIOLOGY
    • Fever is a common presenting complaint with
    a variety of causes ranging from benign to
    terrifying and life threatening!
    • 70-80% of febrile patients over the age of 65
    will be admitted to hospital
    • 7- 9% incidence of death within 1 month of
    admission
    key clinical question

    deciding whether infection is


    likely enough to warrant
    antimicrobial administration
    APPROACH
    APPROACH (1)
    APPROACH (2)
    APPROACH (3)
    If the patient look sick
    start early broad-spectrum
    antibiotics to cover
    suspected source
    What's the most accurate way of measuring
    core body temperature?

    • gold standard is a temperature probe on a


    pulmonary artery catheter… not often feasible!
    • esophageal, bladder or rectal probes are next best
    • axillary and tympanic measurements are often
    unreliable
    • oral temps are highly biased by smoking, consumed
    liquids and hyperventilation
    How high must a fever be to necessitate
    rapid cooling interventions?

    Sustained temperatures above


    41.0ºC are rare but can be
    damaging to neural tissues and
    require rapid cooling (eg. misting,
    fans, cooling blankets)
    Four factors that blunt the febrile response

    Advanced Age
    Immunosuppression
    Malnutrition
    Chronic Disease
    Takeaways
    • Not all fever is from an infectious source. Keep a broad
    differential
    • Blood cultures are not a routine and should be deployed in
    clinical scenarios (e.g. septic shock) or when the results would
    affect patient care.
    • CRP, PCT, and ESR can be helpful in certain patient care
    scenarios as adjunctive information when trying to establish
    the source of a fever as infectious in etiology.
    • Not all septic patients have fever! Those without fever have
    worse in-hospital outcomes.
    • Use your clinical judgment when deciding whether to treat a
    fever—not all fevers need to be treated with anti-pyretics.
    References
    • http://www.emdocs.net/evaluation-fever-emergency-department/
    • https://canadiem.org/wp-content/uploads/2019/03/CRACKCast-
    E200-Fever-in-the-Adult-Patient.pdf
    • https://canadiem.org/wp-content/uploads/2016/09/CrackCast-
    Shownotes-Episode-12-Adult-Fever.pdf
    ΠΕΡΙΣΤΑΤΙΚΟ
    • Άνδρας 30 ετών, περιπατητικός με εμπύρετο
    εώς 39ΟC από 3ημέρου με συνοδό
    φαρυγγαλγία
    • Ιατρικό ιστορικό- ελεύθερο
    • Αντικειμενική εξέταση φάρυγγα:
    - εξέρυθρα παρίσθμια
    -διόγκωση αμυγδαλών με παρουσία
    λευκωπού εξιδρώματος
    Κλινική εικόνα
    • Α:αεραγωγός βατός
    • Β:Sat 97%(FiO2 21%) A.Ψ. ομότιμο άμφω
    19 αναπνοές/λεπτό
    C:ΑΠ=110/80, ΜΑΠ=90, 105 σφύξεις/λεπτό
    S1-S2 ευκρινείς, ρυθμικοί
    HΚΓ:φλεβοκομβική ταχυκαρδία
    D: Κλίμακα Γλασκώβης=15/15
    E: θερμοκρασία=39o
    Διαφορική διάγνωση
    • Στρεπτοκοκκική φαρυγγοαμυγδαλίτιδα
    • Λοιμώδης μονοπυρήνωση
    • CMV Λοίμωξη
    • HIV
    • Επιγλωτίτιδα
    • Οπισθοφαρυγγικό και περιαμυγδαλικό απόστημα
    • Θυρεοειδίτιδα
    • Γαστροοισογαγική παλινδρόμηση
    • Όγκοι του λάρυγγα ή του στοματοφάρυγγα
    • Σύνδρομο Lemierre(σηπτική θρομβοφλεβίτιδα της
    σφαγίτιδας)
    • Κυνάγχη Ludwig
    Εργαστηριακός έλεγχος
    • WBC=10.00K/Μl
    • PMN=53%
    • Λεμφοκύτταρα 12% άτυπα
    • PLT=140.000
    • Hb=14,4g/dl
    • HCT=44,2%
    • CRP=70
    • SARS-CoV-2(PCR)=αρνητικό
    • SGOT=42U/L
    • SGPT=45U/L
    • γ-GT=20 U/L
    • Μοnotest=αρνητικό
    • Strep-test=αρνητικό
    Απεικονιστικός έλεγχος
    • Ro θώρακος
    • U/S άνω κοιλίας:
    ηπατομεγαλία
    σπληνομεγαλία
    θρόμβωση πυλαίας φλέβας
    Οδηγίες
    • Κλινδαμυκίνη 300mgx3 για 10 ημέρες
    • Μεθυλπρεδνιζολόνη
    • Αναλγητικά και αντιπυρετικά
    • Γαργαρισμοί
    • Ενυδάτωση
    • Ανάπαυση
    Επιπλοκές
    • Φαρυγγοαμυγδαλίτιδα μικροβιακή
    • Ηπατίτιδα
    • Εγκεφαλίτιδα
    • Μηνιγγίτιδα
    • Guillain Barre
    • Πνευμονία
    • Μυοκαρδίτιδα
    • Περικαρδίτιδα
    • Ρήξη σπλήνα
    • Θρομβοκυτταροπενία
    • Αναιμία
    • Απόφραξη αεραγωγού

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