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* 53yo Japanese M 3/10 CP no hx w pallor who is reluctant to answer questions. Why admit
a age
b gender
c pain level
d ethnicity
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D ethnicity
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*Post of day 3, febrile WBC 15,000. esinophils 9%. cults negative. why...
a drug fever
b viral infection
c malig htn
d bacterial infection
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Drug fever
esino high-->alergic rxt
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Pain def
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Subjective perception of distress
5th vital sign
subjective findings most reliable indicator of existence and intensity of acute pain
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Acute vs chronic pain
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Acute <6m --> tissue damage
chronic > 6m continual or episodic, usually need combo therapy
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Locations of pain...4
describe
give example
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Cutaneous-skin/surface ie sunburn
visceral- poorly localized as w internal organs
abdomen-GB/PU
Somatic-non localized, origin muscle, bone,
nerve, vessel, supporting tissue
ie) sprained ankle "soft tissue"
Neuropathic-freq tumor, invol nerve pathway injury
or compression ie) herpes zoster, siatic
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*WHO ladder of pain management
ie) CA pain
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3 steps
1) asa, nsaid, acetaminophen (stick w it even if move up)
2) above + narcotic (tylenol 3, lortab, darvocet)
3) above + major narcotic (MScotin)
+/- adjuvant SSRI, gabapen, or antidepres
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Fever def
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Temp above normal (37C)=98.6F
38.3C=fever
common used to monitor for infection.
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Causes of fever (10)
BACMHCGEMN
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-Bacterial (only to get ABX), viral, ricket, fungal paras infection
-Auto immune (SLE, arteritis)
-CNS (cerebral hem, brain tumor, MS) interfer w thermoreg. process
-Malig (primary and liver mets)
-Hematologic (lymphoma, leukemis)
-CV (MI, phlebitis, PE)
-Endo (hyperthyr, pheochromo)
-misc cause (familial mediterranean fever, hematoma
-neuropleptic malignant syndrome (antipsychotics such as thorazine) tx w fluids to flush out
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Tx of fever
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ABX only for microbe
antipyretics
tx underlying cause
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*seritonin syndrome
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OD on SSRI --> FLUIDS
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*malignant hyperthermia/malignant hyperpryexia
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Ie) got succs for intubation-->tx: fluids/cooling blanket
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*#1 cause post-op fever
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Atelectasis
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*if called about post op fever...1st question is...
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Lung sounds and I/O
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*4 main causes post-op fever (non infectious)
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-atelectasis #1
-inc basal metabolic rate-look at strend. was it a steady elevation over 8hrs? -->bug
-dehydration
-Drug rxt Amphotericin B (often premed)& Bactrim common suspects. dose3-10 can cause rash even if no prob B4
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Infectious causes post op fever
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-usually subj complaints and shift left
-wbc > 30000 usually not infection [norm 5-10] sinusitis 10-12, CAMRSA 17, sepsis 20 -Surg incision -IV sites -catheter site -lung -sinusitis, NG tubes source -abscess (eg. intra-abdominal) |
