Care of the sick with chills, fever

FUNDAMENTALS OF FIRST AID
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Care of the sick with chills, fever

Fundamentals of First Aid (OPMP)

Fever - this is a reaction of the body, manifested by an increase in body temperature in response to the introduction of an infection or the absorption of toxic products due to tissue damage. Fever is based on a violation of thermoregulation associated with metabolic disorders. During fever, heat transfer increases significantly.

Fever depends on the cause infectious и non-infectious origin. In both cases, its development is associated with the effect on thermoregulatory centers of special chemicals that arise in response to infection or toxic metabolic products. In infectious fevers, these substances are microbial poisons, as well as products of metabolism and decay of microbes. In non-infectious fevers, these toxic substances can be formed and absorbed from dead tissue, from areas of hemorrhage, etc. Fever can occur with diseases and damage to the central nervous system (tumors, injuries).

Fevers vary in height, duration and nature of daily temperature fluctuations.

Temperature is distinguished by height subnormal (35-36°C), normal (36-37°С) and subfebrile (37-38°C).

With moderate fever, the temperature fluctuates between 38-39°C, with high fever - 39-40°C. Temperatures reaching 40-41°C are life-threatening. The duration of fever varies short-term (from several hours to 1-2 days), acute - up to 2 weeks subacute - up to 6 weeks chronic - over 6 weeks.

According to the nature of temperature fluctuations, the following types of fevers are distinguished:

general fever - high, prolonged, with daily temperature fluctuations of no more than 1°C; typical for patients with lobar pneumonia, typhoid and typhus;

laxative fever has daily temperature fluctuations of more than 1°C, with a drop below 38°C; observed in focal pneumonia, purulent diseases;

debilitating (hectic) fever - prolonged, with daily temperature fluctuations up to 3-4°C; noted in sepsis, purulent diseases, and severe pulmonary tuberculosis;

perverted fever, which is similar in nature and degree of temperature increase to hectic, but in the morning the temperature can be high and in the evening normal; observed in sepsis and severe forms of tuberculosis;

atypical fever is characterized by an indefinite duration and various daily temperature fluctuations; observed in rheumatism, dysentery, influenza and other infectious diseases;

intermittent fever occurs, for example, with malaria, it resembles hectic, but temperature increases can last from one to several hours and recur after 1-2 days, depending on the type of pathogen and its virulence;

returnable fever is characterized by a regular alternation of highly febrile and fever-free periods lasting several days; characteristic of relapsing fever;

undulating fever is characterized by a gradual increase and gradual decrease in temperature; observed in brucellosis, lymphogranulomatosis.

A decrease in temperature over several hours is called crisis or a critical drop in temperature, for example, with lobar pneumonia, typhus, malaria.

A decrease in temperature over several days is called lysis, for example, with typhoid fever, bronchopneumonia. A lytic decrease in temperature is most favorable for the patient.

In the body of a healthy person, the processes of heat generation and heat transfer are in a certain balance, which helps maintain body temperature at approximately the same level. The body temperature of a healthy person is 36-37°C, in children it is 0,5-1°C higher, in older people it is correspondingly lower, which is due to an increase in oxidative processes in children and a decrease in them in the elderly. The intensity of oxidative processes in women changes during the menstrual period, which sometimes entails an increase in temperature by several tenths of a degree.

An increase in temperature at the onset of the disease is usually accompanied by tremendous chills: a feeling of cold, trembling of the hands and jaws, and cyanosis of the extremities. This happens because the skin vessels narrow sharply, blood flows to the internal organs. In this case, the patient should be put to bed, covered, warmed with heating pads, and given plenty of hot drinks. The chill ends with a sharp rise in temperature. During the period of rising temperature, heat generation prevails over heat transfer.

In addition to disruption of thermoregulation, fever disrupts the activity of all organs and systems. First, the metabolism is disrupted: combustion processes are activated, while liver carbohydrates and fats from adipose tissue are burned, and proteins undergo breakdown. Due to decreased appetite and weakened functions of the digestive organs, the supply of nutrients to the body decreases, which leads to dehydration and exhaustion during fever.

To replenish the body's losses and increase its resistance, patients should be fed high-calorie semi-liquid food 6-7 times a day, using the evening and even night time, when the temperature drops slightly.

During a period of high fever, intermediate metabolic products accumulate in the patient's body, the excretion of which decreases due to a decrease in kidney function. In this case, it is of particular importance to introduce a large amount of fluid into the body, which helps reduce the concentration of harmful substances in the blood and ensures the vigorous removal of toxins not only by the kidneys, but also through the skin and mucous membranes. Limiting table salt in the diet increases urination. To prevent the formation of sand and stones in the urinary tract - when treating febrile patients with sulfonamide drugs - abundant alkaline drinking is recommended.

In febrile patients, dry mucous membranes of the mouth and lips are noted; the tongue becomes coated, cracks appear on the lips and tongue. The cracks are lubricated with petroleum jelly, glycerin or a 5% solution of borax with glycerin. The oral cavity can be irrigated with a 3% solution of hydrogen peroxide, a weak solution of potassium permanganate, or a 2% solution of borax.

Authors: Aizman R.I., Krivoshchekov S.G.

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