- Consider ED transfer; OR
- Consider single-dose Acetaminophen (Adults: 1300 mg, Peds 20 mg/kg)
- Observe in 30-45 min. If appearance unchanged, send to ED.
Fever ≤3 Days’ Duration
Seek localizing signs or symptoms. If nothing but malaise, myalgias, ? mild headache → Dx Viral Syndrome Be sure there’s no obscure-but-potentially-lethal possibility:- Malaria (recent foreign travel in rural tropics)
- Rocky Mountain Spotted Fever (fever + headache, April to Sept., in endemic area)
- Meningococcemia (unexplained macules or petichiae)
- Endocarditis (Injection Drug Use, Prosthetic Valve, diseased Native Valve, Hx of Endocarditis)
- Diabetic Ketoacidosis (tachypnea; urinary glucose & ketones elevated)
- AIDS (known HIV+ with low T-cells; risk factors; clinical clues on exam)
- Stevens-Johnson / Toxic Epidermal Necrolysis / Toxic Shock (excessive skin / muscle pain; target lesions, bullae, or “sunburn,” esp. if mucus membrane involvement)
- Caution with Elderly & Compromised Hosts
- Measles: “3 C’s” (Coryza + Conjunctivitis + Cough); Koplik”s Spots
Fever ≥4 Days’ Duration
Consider diseases listed above. Seek new rashes (measles, rubella, roseola, B19 parvovirus).
Also Order Basic Tests:- CBC (high WBCs = occult bacterial infection; neutropenia)
- Urinalysis (Pyelonephritis)
- Chest X-ray (Pneumonia)
- Consider LFTs (for hepatitis, Mono)
- Consider HIV Viral Load (PCR) if risk factors
If appears at all ill: send to ED for imaging, cultures, & I.D. evaluation / admission
If doesn’t appear ill, constitutional symptoms not progressive: consult I.D. if fever persists 7 days. Seek exposure clues:- Travel
- Pets
- Tick bites
- Foods
- Occupational
- Sexual
- Drug fever
- Venous thrombosis
- Connective tissue disease
- Malignancy
See posting Fever.
DiagnosisDude 