ICU fever

marienm, RN, CCRN · Feb 22, 2017

When our patients have standing PRN orders for Tylenol or Ibuprofen for a fever, it's usually for 'Fever > 38.5 C' ...101.3F. If they have one of those orders, I'll usually give the med, especially if their HR is high. We're supposed to notify the team for any pt with SIRS criteria (T> 38.2, HR > 90, RR> 20 or WBCs 12) so if they want cultures they can order them and theoretically we could draw them while the fever is at its peak before treating it.

My unit sees burn patients, and they often have temperatures and high HR from catecholamine release, damaged skin, and pain. For the first few days we tend to shrug off a high temp (if there are no other concerning signs) and just treat the fever for the patient's comfort and to preserve their nutrition status. After a few days if they are still doing it, we'll get cultures.

We also see a lot of surgical patients (Whipples, liver resections, exlaps with bowel resections, some orthopedic patients, some ENT patients). For these, it really depends on which doctor is treating the patient. Some are against treating anything below 39C (103.9ishF). These patients often have contraindications to NSAIDS and/or Tylenol anyway. I'll still notify the team, but we might do nothing other than turn the room temp down or put a fan on the patient.

Non-medication ways to control temperature that we've used include cooling blankets, ice packs, cold water lavage of the stomach, and therapeutic hypothermia (like you would do for a cardiac patient).

MYSTICOOKIEBEAR · Mar 6, 2017

101.5 is when we draw cultures unless they are post op day 0. If you have exhausted your pharmacological options you can bathe them with cold water, ice packs, cool the room down, take all of their sheets off, cold towel to the head, if that doesn't work a cooling blanket does the trick.

One time I had a patient who was on the floor who earlier that day had an IR procedure and transferred down to us with a 104.3 fever at around 03:20, was delirious, straight up looked like he was seizing with how bad his rigors were and on the verge of coding. They had to have stirred up something fierce in IR maybe a loculated pocket of some nasty bacteria. The funny thing was his BP was rock stable and was only on 2lnc but things looked like they were going to get bad i.e. code, intubate, line.

I took all of the information, looked at the this guy who looked like he was seizing and I am embarrassed to admit that I literally thought to myself "YOLO, ice bath time!" :yeah: I had never even heard of it being done to a patient before and have only personally had the pleasure of an ice bath in my Brazilian Jiu-Jitsu/Wrestling/MMA days. I took a bucket, filled it with ice and water, threw towels in, and then proceeded to cover him head to toe with them. Basically I gave him an Ice Bucket challenge, years before that was a thing :roflmao: , and much to his dismay :sour: . He was PISSED and still delirious, but I was able to talk him through it.

Although some may consider the ice bath an archaic strategy, it was a highly effective one. By 0700 I had him up in the chair, temp 97.6, completely lucid, on room air, and talking like nothing happened. My philosophy is that I will do whatever I need to do to speed up a patient's convalescence in an aggressive but controlled manner and achieving this with interventions that have the least amount of risk and a much higher reward .