GP's advice: handling swine flu fever
Updated on 28 July 2009
Yesterday, a patient asked me if I was going to take her temperature and she looked really disappointed when I said "no", writes Dr Peter Stott.
I will let you into a secret. I have never been a big fan of thermometers. My clinical teachers taught me that the height of a patient's temperature had less to do with the illness and more to do with the environment. A hot room would result in a hot patient.
Fluctuations in the patterns of temperature can help with diagnosis because some illnesses like typhoid and malaria produce a fever which varies rhythmically; but the height of a temperature is less important.
"If you can't tell that a patient is feverish from the end of a bed," they said, "you don't deserve to call yourself a clinician."
In this swine flu epidemic however, the height of the temperature has become part of the new currency. Anything over 38 degrees centigrade puts patients strongly in line for antiviral therapy.
Before we take this on face value however, the clinician needs to know what the room environment is like, how the patient has been managed and what attempts have been made to bring the temperature down.
Is the room adequately ventilated and have the windows been opened to keep it cool? Has the central heating been turned off? Have the quilts and duvets been removed and replaced with a thinner sheet? Have those thick pyjamas been stripped off and changed for a singlet?
Children will get a high temperature faster than adults. They have relatively small body surfaces areas compared with their body volume. So they lose heat more slowly and their temperatures go higher.
Children sweat poorly too. So tepid sponging with warm water provides them with artificial sweat and cools them down faster. Everyone needs to drink plenty of watery drinks so they can sweat freely. The evaporation takes heat out of the skin.
"In this swine flu epidemic, the height of the temperature has become part of the new currency."Dr Peter Stott
Aspirin should be avoided in children and adolescents less than 16 years of age because of a rare side effect called Reye's syndrome. Ibuprofen is preferred but both will help to bring down a fever in adults.
Paracetamol is easier on the stomach and OK for children. It is also better for people who have a history of stomach and duodenal problems like ulcers, erosions and heartburn. Paracetamol will ease the aches and pains but is less good at reducing a temperature. Lots of proprietary fever medicines contain a mixture. So look at the ingredients before you buy.
When you have a fever, you feel coldest as your temperature is rising. At this point people usually pile on the blankets. But paradoxically, if you take off the thick bedclothes and replace them with a sheet, you will tend to feel less cold because your temperature will rise less fast.
A few children have convulsions during feverish spells. They usually occur as the temperature is rising and once this has happened, the danger is past. Most of these children will grow out of the tendency with as they get older.
During my career as a GP, I have only occasionally carried a thermometer in my bag. My clinical teachers taught me that their two main purposes were to stop people talking and to gain a few minutes while you thought of what to do next.
The few thermometers I have had were mercury thermometers which were always breaking in my bag. A few years ago they were banned by 'Health and Safety' because the mercury was a danger to health.
I have tried the plastic strips which you hold to your forehead and they seem reasonably accurate. I also have an electronic thermometer given to me by a drug rep. I think I will have to dig it out.
