Originally Posted by starcandy
I have pt with a fairly new spinal cord injury fx C 3-4 . Pt is a quad and vented and has chronic fevers. I just learned that the elevated temp originate from his neuro condtion. Medicating with Tylenol I find is largely ineffective in decreasing the temp. I applied a cooling blanket before I left this morning. Any tidbits would be helpful and where can I find additional info?
Neurogenic temps originate from injury to the hypothalamus, not the cord. Literally all cord injury patients with fever will have infection somewhere. Keep in mind that fresh injuries won't typically have elevated WBC's or other s/s of infection because of the high doses of steroids they receive, which are typically followed by prophylactic abx. And it's a guarantee that ALL SCI patients will have Bacteriuria...and I mean ALLLLL!!!!! Their spinchter doesn't work correctly & they retain urine, leading to infection. In the old days most SCI patients died of Bacteremia originating from UTI. So, when your SCI patient has chronic fever, they most likely have chronic Bacteriuria. Have u tried a combo of both NSAIDS & Tylenol? This combo is typically effective for these patients (alternate doses of each so that both are on board at all times). If this doesn't work u may have to rely on cooling blankets, cool ambient air in the room, fans, etc. But don't confuse this with true neurogenic fever. Also, u might be suprised to find that this patient might have suffered a head injury at the same time (this is a high level injury which leads me to suspect that this is the case) as the SCI which might have led to true neurogenic fever. Often this does not resolve even after the patient recovers from the initial insult.
Hope this helps!
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