Fever, Fever seizures, Heatstrokes

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1. Definition
   1. Fever
      1. The body's temperature is⬆︎
   2. Fever seizures
      1. Convulsions, occurs in young children, triggered by fever
   3. Heatstroke
      1. The body overheats, a result of prolonged exposure/physical exertion in high temperatures
2. Symptoms
   1. Fever
      1. Preferred method to measure temperature according to age
         1. < 5 years old
            1. Rectal
         2. > 5 years old
            1. Oral
      2. Rectal > 38 38 °C (> 100, 4 °F)
      3. Oral > 37,5 °C (> 99,5 °F)
   2. Fever seizures
      1. shaking, moving arms & legs on both sides of the body
      2. eyes may roll back
      3. may stop breathing for a few seconds
      4. might vomit, urinate, or pass stools
   3. Heatstroke
      1. mental changes (e.g. confusion, delirium, or loss consciousness)
      2. nausea, vomiting, can cause severe dehydration
      3. rapid, shallow breathing
      4. red, hot, dry skin
3. Causes
   1. Fever
      1. Infections
      2. arthritis
      3. hyperthyroidism
      4. cancers
      5. immunizations, drugs (drug fevers)
      6. severe trauma or injury
   2. Fever seizures
      1. rapid ⬆︎ in body temperature
   3. Heatstroke
      1. failure of the body's temperature-regulating mechanism
         1. when exposed to very ⬆︎ temperatures
4. Risk Factors
   1. Heatstroke
      1. chronic illness
      2. infant, young child, elderly
      3. working or exercising in the heat
      4. being homeless
      5. being in a car that is parked in the sun
   2. Fever seizures
      1. Family history, 1st degree relative
5. Complications
   1. Fever
      1. Complications are rare
         1. 41℃ (105.8°F) or less doesn't cause complications
         2. Fever is the body's normal response to infections & other condition
   2. Fever seizures
      1. Can be frightening but they aren't usually harmful
         1. It's always recommended to consult a doctor if it occurs
         2. Protect the child from injury during seizures
   3. Heatstroke
      1. Medical emergency
         1. Can be deadly because ..
            1. it can cause severe dehydration
            2. Temperature can rise > 41.7°C (107°F)
               1. This can cause brain damage
6. Treatment
   1. Fever
      1. Medications only If pain or discomfort
         1. acetaminophen (e.g. Tylenol)
         2. NSAID's e.g. ibuprophen (e.g. Advil)
         3. acetylsalicylic acid (e.g. Aspirin)
            1. Don't use if < 18 years old
               1. Reye syndrome risk
      2. Non pharmacological treatment
         1. Stop activity (Rest)
         2. Get out of direct sunlight
         3. Keep cool
            1. Keep room at 21°C or less
            2. Dress lightly
            3. Don't use rubbing alcohol or cold showers to keep cool
         4. Rehydration drink to replace fluids and minerals
            1. 360 ml orange juice without sugar added + 600 ml cooled boiled water + 1/2 tsp salt
            2. Home made solutions must be discarded after ..
               1. 12h if kept at room temp.
               2. 24h if kept refrigerated
   2. Fever seizures
      1. It lasts < 5 min
         1. No treatment
            1. Consult doctor anyway
      2. it lasts > 5 min
         1. diazepam gel intrarectal (IR) (Diastat)
            1. Consult doctor even if seizure stops
            2. If ⊘ available or seizure ⊘ stop in spite tx ➪ Emergency, go to ER
7. Refer to Dr / Seek medical attention
   1. Children < 6 mo
   2. Signs/Risk of dehydration
      1. thirstier than usual
      2. darker or less urine than usual
      3. unable to drink enough
   3. Shortness of breath or persistant cough
   4. temp. > 40 ℃ (104°F)
   5. Fever lasts > 3 days
   6. Fever seizures
   7. Child unusually indifferent/irritable, or lethargic (very sleepy, hard to wake)
   8. Emergency
      1. Symptoms of heatstroke
      2. Fever seizures last > 5 min
      3. Contact immediately a Canadian Malaria Network contact if there's fever within 12 months of traveling in malaria risk area
8. Prevention
   1. Fever seizures
      1. Risk of recurrence is higher
         1. 1st episode: temperature < 40 °C or child < 12 months old
         2. child 6 months - 3 years old
         3. child attends a nursery
         4. 1st degree relative family hx
         5. 5-10 days Post-Vaccination
      2. Not indicated (effective) for prevention
         1. Antipyritics e.g. acetaminophen, NSAID's, Aspirin
         2. Anticonvulsivants
      3. Benzodiazepines (BZD)
         1. If there's fever & patient has a hx & risk factors of recurrence of fever seizures, clobazam x 48h
            1. 5-20 mg/day depending on weight
   2. Heatstroke
      1. Stay in cool environment & dress light on very hot/humid days
      2. Avoid exercising or working outdoors (if possible) on very hot & humid days
      3. Keep hydrated
         1. Avoid drinking alcohol, caffeine or hot beverages
9. Last update: 13/12/2016
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