high fever chills
Introduction
Introduction The chill is the first sound of high fever. During the chill, the body temperature has risen. In the early stage when the fever is not too high, sometimes the patient has only a sense of chills in the body, and there is no shudder, which is called chills. Most of the chills occur before acute febrile illness. The pathogen of infectious diseases, when the body causes fever, the patient's body chills, goose bumps and tremors, that is, muscle involuntary activities, this is called aversion to cold, referred to as chills. Encourage drinking water, keep your tongue moist, and urinate.
Cause
Cause
(1) Acute high fever:
1. Infectious diseases: early acute infectious diseases, acute infectious diseases of various systems.
2. Non-infectious diseases: heat syndrome, neonatal dehydration fever, intracranial injury, convulsions and epileptic seizures.
3. Allergic reactions: allergies, allogeneic serum, vaccination response, infusion, transfusion reactions, etc.
(2) Long-term high fever:
1. Common diseases: sepsis, Salmonella infection, tuberculosis, rheumatic fever, juvenile rheumatism, etc.
2. Rare diseases: malignant tumors (leukemia, malignant lymphoma, malignant histiocytosis), connective tissue disease.
Examine
an examination
Related inspection
Sputum bacterial smear test urine routine blood blood and bone marrow bacteria culture nasal sputum intradermal test
High fever and chills are common symptoms of many diseases, so it is necessary to investigate and analyze the fever patients in order to find out the cause. Generally, it must be done from the following aspects.
(1) Detailed and accurate collection of medical history, pay attention to age, disease season, epidemiological history, history of infectious disease exposure, history of vaccination, rapid onset, length of disease, heat type and accompanying main symptoms.
Newborns can have dehydration heat. Infants and young children in the south, summer heat can occur when the heat is hot. In winter and spring, respiratory infections, epidemic cerebrospinal meningitis, measles and other common occurrences; in summer and autumn, acute enteritis, bacillary dysentery, Japanese encephalitis, typhoid fever, etc. are more common. Infectious diseases often have a history of epidemiology, and should be carefully asked about the history of exposure. Pediatric respiratory infections, acute infectious diseases, etc. are often onset, and the course of disease is shorter. Tuberculosis, typhoid fever, blood diseases, rheumatic fever, heat syndrome, bacterial endocarditis and other onsets are mild, and the course of disease is longer, often more than two weeks. Sepsis, acute miliary tuberculosis, deep abscess and other relaxation heat; typhoid fever, paratyphoid fever, typhus typhus as heat retention; malaria is mostly intermittent heat; leukemia, connective tissue disease, malignant tumor, etc., different types of heat, no certain law. The heat type is very important for the diagnosis of fever when it has not been treated with special drugs such as antibiotics and corticosteroids, but it has little diagnostic value for small infants and newborns.
When inquiring about fever, you should pay attention to the specific clinical manifestations of each system. For example, respiratory infections often have cough and shortness of breath. Digestive tract infections often have nausea, vomiting, abdominal pain, and diarrhea. Urinary tract infections include frequent urination, urgency, and dysuria. Central nervous system disorders, vomiting, convulsions, coma and so on. Fever with jaundice common liver bacterial or viral inflammation, tumor; associated with sweating common in connective tissue disease, sepsis, etc.; with cold warfare are mostly bacterial infections such as sepsis, deep abscess. In the early stage, there are no specific clinical manifestations and signs, and combined with the characteristics of the history of the disease to consider typhoid, sepsis, tuberculosis and so on.
(B) comprehensive and careful physical examination: the examination should be detailed and comprehensive, combined with medical history and symptoms, and then in-depth examination.
Oral in many fever patients, pathological changes are common. Such as tonsillitis can be seen tonsils redness or purulent secretion; herpes pharyngitis can be seen in the pharynx and other areas of herpes and ulcers; measles early in the buccal mucosa with Coriolis; diphtheria can be seen in the throat and tonsils have white pseudomembrane.
Pay attention to the distribution and morphology of the rash. Staphylococcus aureus, streptococcal infections are common with scarlet fever-like rash; blood diseases, epidemic cerebrospinal meningitis, epidemic hemorrhagic fever and other skin may have bleeding points; rheumatic fever can be seen in ring erythema; viral infection, connective tissue disease, sepsis Bacterial endocarditis, histiocytosis X, mucocutaneous lymph node syndrome and many drugs can cause rash, but their morphology and appearance are different.
People with good mental state during high fever are often mildly infected. Such as lethargy, apathetic, unconscious, with meningeal irritation, suggesting intracranial infection. In the early stage of infant intracranial infection, meningeal irritation is often not obvious, but the performance is apathy, lethargy, irritability, nervous or full of sputum, etc., must be alert to intracranial infection.
Hepatosplenomegaly is common in leukemia, connective tissue disease, inflammation of the hepatobiliary system, typhoid fever, sepsis, malaria, and tumors. Lymph node enlargement can be seen in blood diseases, infectious mononucleosis, mycoplasma infection, lymph node syndrome of the skin and mucous membranes. Local lymphadenopathy, tenderness, should pay attention to find adjacent areas with or without inflammatory lesions.
(3) Laboratory inspection: Firstly, the general inspection will be carried out. According to the general screening results, it is decided to further inspect the project and try to avoid the purposeless casting inspection.
Common tests for blood, urine, and feces are preferred items for screening. The total number of white blood cells and neutrophils are increased, and more are considered bacterial infections; those with reduced weight are more viral or bacilli infections. If you suspect sepsis, intestinal and urinary tract infections, you need to send blood, feces, and urine separately. In addition to routine examinations, various puncture fluids are sometimes sent for culture or smear examination. For example, meningococcal smear and cerebrospinal fluid smear in patients with epidemic cerebrospinal meningitis can find meningococcal bacteria, blood smears for malaria can find malaria parasites, and diphtheria pseudomembrane smears to check diphtheria bacilli.
If necessary, check the fatda reaction, the external Fischer reaction, the heterophilic agglutination test, the condensation set test, etc., to help the differential diagnosis. Rheumatoid fever or rheumatoid disease was examined for anti-streptolysin O or rheumatoid factor, respectively. Patients with suspected viral infections may have early rapid diagnostic tests for immunological aspects. Patients with repeated infections caused by immunodeficiency disease can be used for serum immunoglobulin and cellular immunity and complement determination. Blood diseases should be checked for bone marrow. Suspected tuberculosis requires a tuberculin test. Patients with suspected biliary tract infections are often examined and cultured for duodenal drainage, and often have meaningful results. In short, the relevant examinations can be carried out according to the condition of the disease, but it is necessary to pay attention to the analysis of the results of the examination, to eliminate false positives or false negatives caused by errors and pollutions such as sampling or operation.
(D) X-ray and other examinations: chest X-ray examination is helpful for the diagnosis of lung and chest diseases. Others, such as malignant tumors, can be selected for CT, nuclear magnetic resonance, angiography, radioisotope, B-mode ultrasound, and living tissue according to the site, which is also necessary.
Diagnosis
Differential diagnosis
Identification:
Repeated high fever: body temperature repeatedly reached 39.1 ~ 40 °C. High Fever is clinically critical. Common diseases, sepsis, Salmonella infection, tuberculosis, rheumatic fever, juvenile rheumatism, etc.
High fever does not return: fever is a common symptom of many diseases. High Fever is clinically critical. Normal body temperature is usually measured by anal temperature of 36.5 to 37.5 ° C and temperature of 36 to 37 ° C. Under normal circumstances, the temperature of the sputum is 0.2 to 0.5 ° C lower than the mouth temperature (sublingual), and the temperature of the anus is about 0.5 ° C higher than the temperature of the sputum. Although the anus temperature is more accurate than the temperature, it is often based on various reasons. If the value of the temperature measured by the patient is as high as 39.1 to 40 °C for a long time, it is called high fever.
High fever: due to a variety of different reasons, the body's heat production is greater than heat dissipation, so that the body temperature exceeds the normal range is called fever, and the fever is divided into low heat, moderate heat, high heat and super high heat according to the heat level. High heat means that the body temperature exceeds 39.1 °C.
The chills are often accompanied by high fever, mostly central high fever:
1. Suddenly high fever, body temperature can rise linearly, reaching 40~41°C, continuous high fever for several hours to several days until death; or body temperature suddenly drops to normal.
2. The temperature of the trunk is high, the temperature of the limb is second, and the temperature on both sides can be asymmetric, with a difference of more than 0.5 °C.
3, although high fever, but the symptoms of poisoning are not obvious, without trembling.
4, no face and body skin flushing and other reactions, the opposite can be expressed as dry skin, reduced sweating, cold limbs.
5, generally not accompanied by increased pulse and respiratory increase with body temperature.
6, no evidence of infection, generally not accompanied by increased white blood cells, or the total number is high, the classification has no change.
7. Due to the integration of dysfunction of body temperature, the temperature of the body fluctuates with changes in external temperature.
8. Antibiotics and antipyretic agents (such as acetylsalicylic acid) are generally ineffective during high fever. This is because the body temperature regulation center is damaged, and the antipyretic drugs are difficult to affect them, so the clinical effect of cooling is not produced. However, it can be effective with chlorpromazine and cold compress.
