Morbidity and mortality increase with age and comborbidities
Most common sources in elderly: respiratory, genitourinary, skin/soft-tissue
Atypical presentations: functional decline, altered mental status
Immediate Evaluation and Management
Critical Findings
Altered mental status
Respiratory distress
Hemodynamic instability
Critical Interventions
Airway management, supplemental O2
Cardiac monitoring
Fluid resuscitation
Empiric antibiotics
Cooling measures (T>41.0°C)
Pathophysiology of Fever
Production of endogenous or exogenous pyrogens
Increase temperature set point in hypothalamus
Patient experiences chills when core temperature < set point
Vasoconstriction, shivering causes fever
Patient experiences euthermia, though may feel malaise, fatigue
Resolution
Patient experiences sweats until core temperature returns to normal set point
References
Blum, F., & Biros, M. (2013). Fever in the Adult Patient. In Rosen’s Emergency Medicine – Concepts and Clinical Practice (8th ed., Vol. 1, pp. 119-123). Elsevier Health Sciences.
