Emergency Minute - What Is A Fever

Join me for a brief discussion on how to define fever, what is it, when should you seek medical attention, and should you treat it.  

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Transcript

Welcome back to emergency minute, this is your host Dr. John Parente bringing you episode three, where we're going to discuss what is a fever. I want to thank everyone who joined in last week to talk about the obviously the transfer crisis the boarding crisis happening in your hospitals right now. That was kind of a fun show to do. And in fact, yesterday ACEP, American College of Emergency Physicians publication put out on their front page and article discussing this very topic of boarding and the transfer crisis in the emergency room. So, it's kind of cool to see that on the front page of their publication. Kdos to them. If you haven't checked out the podcast, take a listen and see what you think. As many of you know, I'm new to this podcast world. This episode is sponsored by nobody, because evidently, I'm not cool enough. So, if you like what you're hearing, and you want to continue helping me with this fight against misinformation and connecting the real world with the medical worlds, I still think there's a huge disconnect. Please remember to share this podcast on social media. And you can pretty much follow me on just about any social media platform at Dr. J. Parente. Appreciate you, much love. 

Alright, so today's topic we're going to talk about is, what is a fever. So, there's obviously a lot of misconception out there about what a fever is. So, the short version is a fever is a temperature of 100.4 or higher. And if you're not an obnoxious American, and you're like the rest of the world, it's 38 degrees Celsius or higher. So that's the short version 99 is not a fever, you know, 100.0 is not a fever, still something you may need to be concerned about. But 100.4 or higher is fever. Now, what is a fever? 

Well, a fever is simply a regulation system by the body where the hypothalamus sets what's called a setpoint. The Setpoint is set here. And let's say when you have this fever, usually due to infection, or inflammation, we'll get to that later, what happens is the body changes the setpoint to a higher level, right? So, you say goes up to 102? Well, then your body sort of intrinsically says, okay, well, I'm at 98.6, I need to get to 102. So, in order to achieve that, I need to do things to get to that temperature. And so that's when you start to feel cold, you feel cold, because your body is shivering. And that's one of the defense mechanisms that the body has in place that allows the shivering to help raise the body temperature in order for you to achieve that setpoint. And that's when people describe chills. And that's when people are asking for blankets when they have a fever, and things like that. So that's the cold side. 

Now, what happens when you get to that new threshold that new setpoint or it goes higher? Well, that's when you start to hear terminology, breaking a fever, what does that mean? Well, you've either hit that setpoint or surpassed it. And now the body says, oh, we need to get lower. So, we're going to do things that were built into the body to lower that temperature. And what that looks like is when you're sweating, and taking your sweatshirt off, and really kind of hot, and that's the body's way of cooling itself to get down to a lower level. So that's sort of physiologically what that fever is now what causes fever, for the most part. 

And again, this podcast is not meant to be like geared towards like medical students and physicians, although I'm happy to have them as listeners too. But for the most part, this is either due to infection or inflammation. And I mean, there are some other causes out there, but just for the sake of this podcast, we'll stick with that. And obviously, the thing that we're worried about is infection, you know, primarily viruses, also bacteria, and those sometimes are the more dangerous variety. And then there's some other rare causes such as you know, fungal infections, etc. So, the question becomes, to treat or not to treat the fever, right? And there's two schools of thought here, both sides kind of makes sense. So, the one side is okay, I feel like garbage, I'm going to go ahead and take some medicine so that I don't feel like garbage that, okay, that makes sense. But also, what happens when you have fever? Well, your heart rate elevates your respiratory rate elevates, you are more prone to getting dehydration, you're not eating as much because you feel like trash. You're not drinking as much, then that's when you start to get dehydrated, you kind of can see how this would spiral. So, there is some validity to saying hey, I'm going to take this medicine so I can feel better. And then maybe give myself a better chance to do the things I'm supposed to do drink fluids, eat foods, etc. And then be able to sort of beat this thing more quickly. So that's kind of the one school of thought. 

Now the other side of that is hey, fever is not necessarily a bad thing, right? I mean, it's the body's way of fighting off this infection. It's the body's immune system mounting a response. Why would I want to take medicine to limit that response? Why would I want to say, hey, I'm sending the troops out to war here with my lymphocytes and the bodies in a white cells and things like that? Why would I want to suppress that response by taking Tylenol or Motrin or things that are going to sort of inhibit that fever, you hear about people trying to ride it out, I sweat it out, I sweat out my fever. And there's some validity to that too, in the sense that, could this be something that maybe gets you through this illness faster? 

Well, you know, unfortunately, in medicine, we do try to stay within the realm of what's evidence based, unfortunate, there's really not great evidence on either side of this, it really comes down to the individual. Me personally, if I have to work or be somewhere, like having conversations with people and things like that, like, I'm going to take the medicine to feel better so I don't feel like complete trash, like talking to people in that kind of stuff. However, if I'm off, and I'm just leaving that kind of stuff, I do try to stay away from those medications. Because I do believe maybe there's some validity to the school of thought that if I let my body do its job, I'll be able to get on the other side of this thing quicker. But I do think for the average person out there, especially for kids, right, it's very reasonable to treat them with medications as long as it's indicated, there's no contraindications. Because average person wants to feel better. And I think is more likely to do the things they're supposed to do eat, drink, etc, and become less likely to end up in the hospital with dehydration and those kinds of things. 

If their symptoms are somewhat managed, especially in kids, like you can tell a 40 year old man, look man up, you've got to drink, you have to eat. If you want to beat this, you have to have some accountability in your healthcare, which I think we've lost in America. That's a whole other podcast. But that's awfully hard to say to a six-month-old, right? I think we can all agree on that. So, I think that's where the difference comes in with treatment. 

When do you go seek medical attention? Well, medical attention, you know, and here's my disclaimer, look, if you feel like you're needing to go see a doctor go ahead, I recommend you call your primary care physician. But as we've talked about, before, the primary care system, our health care system, in general, in this country is already broken. And that's why I think the emergency department serves as America's safety net, we're happy to see you in the ER, honestly, even if it's just some reassurance, because these things can be deadly. You know, we've heard sepsis and things like that. And we want to make sure we're not missing that as well. But you know, we do look at some red flags. What are some red flags for fevers? Well, first and foremost, if you're immunocompromised, you're on chemotherapy, things like that. That's kind of a no brainer. Like at that point, you must seek out medical attention. Some of the other red flags would be if you have fever that's prolonged. So, we've typically defined this as greater than five days. But the asterisk by this is that COVID flu last, like 7,10, 14 days, so that kind of goes out the window a little bit. Like if you have a known diagnosis of COVID, you're going to have a fever for like 10 or 14 days, unless you're just super lucky or you know, whatever. So I think that you still have to be cognizant of that. And I still, like I said, welcome, you'd come to the emergency room. But for the most part with these flu and COVID patients, we really don't do much, as long as they're oxygenating well, and treat their symptoms, there's really not a whole heck of a lot for us to do. But sometimes the patient does need that reassurance. And I think that's okay. 

I think it's important that people need to remember that the average person gets sick about three times per year. So, it's not unusual to get the cough and cold and a flu season and things like that it does happen, especially if you have kids, you know, they're bringing home all the bacteria and viruses from school and everything else. So, some other red flags to consider would be if you start to have symptoms that are like outside of the norm. If you start to have discolored urine, you're worried about dehydration, you're having shortness of breath, you're having pain in your chest, you're having severe abdominal pain, those are some things that are kind of red flags for the fever. And at that point, that's where you want to seek medical attention. Another red flag symptom would be basically a fever without symptoms. So obviously, that can be underlying sepsis, or other sort of more dangerous causes. 

So if you have a fever, but you don't really have any symptoms, you're not having cough or sore throat or runny nose, or you're not vomiting or diarrhea. Those can be obviously sort of some red flags as well, because obviously, you can still have infection that just hasn't been uncovered yet. So that's another reason to potentially seek medical attention as well. And then finally, the other thing to consider is extremes of age, right? So, when you have four week Olds fever is a whole different can of worms that right, like their immune system hasn't fully formed yet, they're very high risk for some pretty nasty infections, especially, you know, as people are starting to choose not to have their children vaccinated. That opens a whole new can of worms. But obviously, fevers in anybody under three months of age is definitely something that you want to get medical attention, especially in the first four weeks like that is absolutely critical. Now, if you look at the other side of that, of course, the elderly, right, so the elderly don't always have a fever, right? And in fact, sometimes their temperatures are low. And we've seen this with sepsis too, like you have an infection but your temperature is actually low and your body is actually hypothermic. 

So that's something that we see as well and that kind of goes along with one of those sort of MythBusters ideas like, well, you know, I don't get fevers or that's not a fever for me, some school of thought there, some of that's kind of nonsense. But some of that may be real, like there are certain people that just cannot mount a febrile response to that infection. And obviously, extremes of age would be one thing to consider, you know, that four-week-old or that 80 year old that has some sepsis, so that's kind of some other red flags to consider. And there's a whole litany of other reasons why you would want to, but those are just a few of the things to talk about, as far as reasons that you would need to seek medical attention. 

So, I think in summary, fever is not necessarily a bad thing, it means the body's doing its job fighting that infection. If you feel that you need to come to the emergency department like I said, we're America safety net happy to see you. Which Don't be surprised sometimes if there's not a whole heck of a lot we do other than maybe reassure you or run some tests or some swabs, our job in the emergency room is to rule out the bad stuff, the sepsis, you know, some other causes bacterial causes, etc. So, don't be disappointed, you must have a little bit of patience to get through this stuff. And again, have some accountability in your healthcare, you can get better if you do the things you're supposed to do. drinking plenty of fluids, eating frequently, given your nutrition as obviously a very important getting lots of rest. The body uses food, water, and rest to fuel the fight against the infection. So it's important that you do those things. So when doctors say listen, get lots of food, plenty to drink and get lots of rest. There actually is science behind that reasoning. 

So please remember to like and share this podcast. Join us next week, we're going to talk about why does my ER visit take so long which be kind of interesting to talk about. And let me know any ideas or topics that you want me to discuss next time The winner will get a free set of steak knives. And then don't forget to like and share on social media. Remember, you can follow me on just about any social media platform at DrJparente. Happy Valentine's to those who choose to celebrate and peace, love and happiness to all my brothers out there. Cheers guys.