Fever vs. Warm Blanket

My ER has no written policy, and I've never heard the docs express an opinion on the matter, but I think most of the nurses at my ER remove blankets. I am probably the only one who DOESN'T, unless the fever is really high.

My reasoning: We're always telling our patients that most fevers are beneficial, with the body increasing tempt to fight the infection. In fact, our ER resists giving antipyretics in adults unless the fever is over 101. And I bet that plenty of nurses and non-nurses are like me...if I have a fever at home, you can bet I'm taking Tylenol and bundling up for comfort. Unless the fever is dangerously high, or I am trying to get an accurate temp reading to determine treatment, I give a blanket.

I give blankets, but I start to talk about not artificially making the fever too high at about 5 blankets. There are times when you could use all the blankets you have and the patient will still feel chilled, until we give them antipyretics.

With adults, yes I do. I agree with the thought already posted that an ill patient who is chilled/shaking/shivering w/ goose bumps is well on his/her way to spiking a temp regardless of blanket or no blanket, and to my knowledge there is no good evidence that giving a warm blanket is going to make the temp spike higher than it naturally would, or withholding a blanket is going to prevent it altogether (I'm pretty sure I've read an article about how the practice of withholding warm blankets in the adult population is not an evidence-based practice, but if I'm mistaken I would be happy to read evidence to the contrary). It's a comfort measure. I think it's almost natural/instinctive to want to bundle up with chills/fever and I have never heard of a case where doing so altered an adult's outcome negatively.

Or maybe the real reason is because patients seem to have enough to complain about without me arguing about a warm blanket. These days I bring them to people by the stackful, even if they don't ask. It's amazing what will make people really happy.

Here's an article that goes a little more in depth about fever interventions in different scenarios. Just briefly skimmed it, but it looks interesting.

http://classic.aacn.org/AACN/jrnlajc...0?OpenDocument

Shivering = blanket. Sweating = sheet. Generally speaking, of course. Shivering is going to jack up temps more than a blanket would, I would think.

There are times when some nurses obviously lack common sense.
(I suppose some of us ER nurses fall into that category)

Like with fever and not giving blankets. I don’t know how many times I’ve overheard a shivering, patient asking for a blanket, only to be refused by the nurse because they have a fever. Ohh Gasp!* So what if they have a fever, I’ll say. "I don’t want their temperature going up, they’ll say."

Well look here’s the deal.

There are two main ways to the body's temperature goes up. The first is when your body’s thermoregulatory mechanisms, coordinated in part by the hypothalamus, are overwhelmed by exogenous heat, i.e. you sit in a car on a hot summer day. Or lay out in the sun for 12 hours... This is hyperthermia. In this case by all means lets hold off on the blankets and go with the usual heat illness treatments: ice packs to the groin and neck, get a fan and maybe a cooling blanket.

Far more commonly (and in this case) you develop a fever from infection. Here, your hypothalamus has decided it is for the greater good to raise your temperature a few degrees in an effort to fight the disease. And warm blankets, cold shower, whatever isn’t going to change anything, your body’s just going to compensate to stay at the new set-point. You have to act on the hypothalamus directly, either by craniotomy or taking a tylenol to alter this setting.
Now, just for the sake of argument, what if a blanket did raise a fever a degree or so. Is it gonna kill the patient? Is it gonna give that disease the upper hand?? No it's simply going to provide some comfort to a shivering patient.

We take these people and strip them down, place them in ill-fitting gowns, stick them for blood, put fingers, plastic, and long rubber tubes in all their holes, keep them in a frightning environment, and restrict their families from seeing them. Then when they ask for a blanket we say no.....because you have a fever?!?!?!

In all my years as a paramedic and nurse and human for that matter, I have never seen a blanket kill anyone with a fever.