tailieunhanh - Chapter 115. Approach to the Acutely Ill Infected Febrile Patient

The physician treating the acutely ill febrile patient must be able to recognize infections that require emergent attention. If such infections are not adequately evaluated and treated at initial presentation, the opportunity to alter an adverse outcome may be lost. In this chapter, the clinical presentations of and approach to patients with relatively common infectious disease emergencies are discussed. These infectious processes and their treatments are discussed in detail in other chapters. . | Chapter 115. Approach to the Acutely Ill Infected Febrile Patient The physician treating the acutely ill febrile patient must be able to recognize infections that require emergent attention. If such infections are not adequately evaluated and treated at initial presentation the opportunity to alter an adverse outcome may be lost. In this chapter the clinical presentations of and approach to patients with relatively common infectious disease emergencies are discussed. These infectious processes and their treatments are discussed in detail in other chapters. Noninfectious causes of fever are not covered in this chapter information on the approach to fever of unknown origin including that eventually shown to be of noninfectious etiology is presented in Chap. 19. Approach to the Patient Acute Febrile Illness A physician must have a consistent approach to acutely ill patients. Even before the history is elicited and a physical examination performed an immediate assessment of the patient s general appearance yields valuable information. The perceptive physician s subjective sense that a patient is septic or toxic often proves accurate. Visible agitation or anxiety in a febrile patient can be a harbinger of critical illness. History Presenting symptoms are frequently nonspecific. Detailed questions should be asked about the onset and duration of symptoms and about changes in severity or rate of progression over time. Host factors and comorbid conditions may enhance the risk of infection with certain organisms or of a more fulminant course than is usually seen. Lack of splenic function alcoholism with significant liver disease intravenous drug use HIV infection diabetes malignancy and chemotherapy all predispose to specific infections and frequently to increased severity. The patient should be questioned about factors that might help identify a nidus for invasive infection such as recent upper respiratory tract infections influenza or varicella prior trauma disruption of .

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