Fever in the ICU
1. Noninfectious Causes
a. Inflammation
(1) Medications (antibiotics, anti-convulsants)
(2) Blood Product...
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Fever in the Intensive Care Unit

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Edward Omron MD, MPH, FCCP
Pulmonary, Critical Care Medicine
Morgan Hill, CA 95037

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Fever in the Intensive Care Unit

  1. 1. Fever in the ICU 1. Noninfectious Causes a. Inflammation (1) Medications (antibiotics, anti-convulsants) (2) Blood Products (3) Vasculitis (4) Pancreatitis b. Vascular (1) DVT or PE (2) Mesenteric Ischemia (3) Hemorrhage into brain, lung, adrenal glands (4) MI (uncommon) c. Metabolic (1) Hyperthyroidism (Thyroid Storm) (2) Adrenal Insufficiency (3) ETOH Withdrawal, DT’s (4) Neuroleptic Malignant Syndrome or Malignant Hyperthermia (5) Serotonin Syndrome d. Neoplasia e. ARDS, Acute Lung Injury, or Acute Interstitial Pneumonia f. Aspiration pneumonitis 2. Infectious Sources of Fever a. UTI b. Vascular Devices c. Respiratory ( pneumonia, abscess, sinusitis, empyema) d. Wound Infection e. Skin / Soft Tissue (decub or cellulites) f. Gastro (C. Diff!, ischemic colitis, hepatitis, cholecystitis) g. Prosthetic Valves or devices (endocarditis) h. Meningitis (unusual except in head trauma or ICP monitor in place) 3. Workup Initial: U/A +Culture, Sputum gram stain + culture, 2 Blood Cultures (aerobic), and CXR. Subsequent studies: arterial and venous blood gases, lactate, amylase + Lipase, CK+CKMB and Troponin, TFT’s, random cortisol + ACTH stim, spiral CT (whole body), Doppler studies of lower extremities, lumbar puncture, bronchoscopy with lavage, thoracentesis, paracentesis, echocardiography, and ophthalmology examination. Edward M. Omron MD, MPH, FCCP Pulmonary/Critical Care Medicine

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