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Fever is not a contraindication for a blanket
Australasian Emergency Nursing Journal (2015) 18, 173
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/aenj
LETTER TO THE EDITOR Fever is not a contraindication for a blanket To the Editor, I am grateful to have had the opportunity to work alongside so many dedicated nurses who strive to provide a high level of care for our patients. It is admirable that nurses are so attentive not just to patients’ clinical needs but also their comfort. This is why I was surprised recently to be chastised for giving a blanket to a patient in the emergency department who complained of feeling cold. The patient’s nurse informed me that the patient had a fever and was therefore not permitted to have a blanket. Subsequent inquiries suggest that this view is not unique. The attempt to ensure that the patient did not receive what was perceived as a harmful intervention is commendable, but the concerns about harm from a blanket in a patient with a physiological fever are misguided. When discussing physiological fevers, it is important to be clear that this means a fever, most often caused by infection, where the fever itself is not pathological but rather is part of the physiological response. During this response, cytokines trigger an increase in the thermoregulatory set point (also known as the hypothalamic set point) in the brain while also acting peripherally to activate other pathways that increase temperature.1 This type of physiological fever will be the case in the majority of patients with elevated temperature in the emergency department. It may seem counter-intuitive to recognise the physiological nature of most fevers given how quick we often are to treat patients with fever with antipyretic medications. What we must recall is that the clinical improvement seen from these medications is not due to the reduction in fever itself but rather the antiinflammatory action of these medications.2 We can be further reassured of the physiological nature of fever by considering a large retrospective study of critically ill patients with infectious fevers that found decreased mortality in patients who had an elevated peak temperature in
the first 24 h in the intensive care unit (ICU).3 This raises the possibility that fever is protective even in these critically ill patients. It is reasonable to conclude that in patients with fever in the emergency department, it is unlikely that a blanket will cause harm and it is likely that it will provide benefit by increasing comfort in a patient who feels cold. Providing a blanket will not create a negative alteration of the underlying physiological elevation of the thermoregulatory set point. Denying patients a blanket in the emergency department on the basis of a physiological fever should not be an accepted practice.
Provenance and conflict of interest The author has no conflicts of interest. This paper was not commissioned
References 1. Mackowiak PA. Concepts of fever. Arch Intern Med 1998;158(17):1870—81. 2. Blatteis CM. Fever: pathological or physiological, injurious or beneficial? J Therm Biol 2003;28(1):1—13. 3. Young PJ, Saxena M, Beasley R, Bellomo R, Bailey M, Pilcher D, et al. Early peak temperature and mortality in critically ill patients with or without infection. Intensive Care Med 2012;38(3):437—44.
Christopher R. Foerster, MSc Paramedic, Final Year Medical Student, Mackay, Queensland, Australia E-mail address:[email protected]
http://dx.doi.org/10.1016/j.aenj.2015.06.001 1574-6267/© 2015 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.
7 May 2015 4 June 2015 4 June 2015
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/aenj
LETTER TO THE EDITOR Fever is not a contraindication for a blanket To the Editor, I am grateful to have had the opportunity to work alongside so many dedicated nurses who strive to provide a high level of care for our patients. It is admirable that nurses are so attentive not just to patients’ clinical needs but also their comfort. This is why I was surprised recently to be chastised for giving a blanket to a patient in the emergency department who complained of feeling cold. The patient’s nurse informed me that the patient had a fever and was therefore not permitted to have a blanket. Subsequent inquiries suggest that this view is not unique. The attempt to ensure that the patient did not receive what was perceived as a harmful intervention is commendable, but the concerns about harm from a blanket in a patient with a physiological fever are misguided. When discussing physiological fevers, it is important to be clear that this means a fever, most often caused by infection, where the fever itself is not pathological but rather is part of the physiological response. During this response, cytokines trigger an increase in the thermoregulatory set point (also known as the hypothalamic set point) in the brain while also acting peripherally to activate other pathways that increase temperature.1 This type of physiological fever will be the case in the majority of patients with elevated temperature in the emergency department. It may seem counter-intuitive to recognise the physiological nature of most fevers given how quick we often are to treat patients with fever with antipyretic medications. What we must recall is that the clinical improvement seen from these medications is not due to the reduction in fever itself but rather the antiinflammatory action of these medications.2 We can be further reassured of the physiological nature of fever by considering a large retrospective study of critically ill patients with infectious fevers that found decreased mortality in patients who had an elevated peak temperature in
the first 24 h in the intensive care unit (ICU).3 This raises the possibility that fever is protective even in these critically ill patients. It is reasonable to conclude that in patients with fever in the emergency department, it is unlikely that a blanket will cause harm and it is likely that it will provide benefit by increasing comfort in a patient who feels cold. Providing a blanket will not create a negative alteration of the underlying physiological elevation of the thermoregulatory set point. Denying patients a blanket in the emergency department on the basis of a physiological fever should not be an accepted practice.
Provenance and conflict of interest The author has no conflicts of interest. This paper was not commissioned
References 1. Mackowiak PA. Concepts of fever. Arch Intern Med 1998;158(17):1870—81. 2. Blatteis CM. Fever: pathological or physiological, injurious or beneficial? J Therm Biol 2003;28(1):1—13. 3. Young PJ, Saxena M, Beasley R, Bellomo R, Bailey M, Pilcher D, et al. Early peak temperature and mortality in critically ill patients with or without infection. Intensive Care Med 2012;38(3):437—44.
Christopher R. Foerster, MSc Paramedic, Final Year Medical Student, Mackay, Queensland, Australia E-mail address:[email protected]
http://dx.doi.org/10.1016/j.aenj.2015.06.001 1574-6267/© 2015 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.
7 May 2015 4 June 2015 4 June 2015