Comments on: Low Grade Fevers

By: Lolo

Lolo — Thu, 14 Mar 2013 06:45:59 +0000

Err…Here’s a story about why “low grade” or non-febrile “fever”, or maybe “subjective fever” is a better terms, is an important piece of the puzzle, even and perhaps especially when it disappears by the time the patient is triaged. I seem, it first glance, like the kind of neurotic somatosizing attention seeker that clot ERs and inspire frustration, disdain, and belligerent blogs: Anxious, wan, complaining of “low-grade fever” and headache that improve miraculously by the time the disgruntled resident who drew the short straw arrives to examine me. In Dec 2011, I presented to the ER of a nationally prominent teaching hospital with all the vague symptoms you might reasonably hate at 3 am on a Friday-Sunday shift. I was told by a smirking resident I had no fever. When I quoted his hospital’s own outreach pamphlet he threatened to call security (clearly my supine position and crushing headache belied murderous intent…) I demanded to see his attending, and we discussed Dr. Smirking’s education. I was then discharged without any treatment or test.

I subsequently discovered, ten days later, that I was suffering chronic CO poisoning within my home.

There is no excuse for this in the NW, where “flu-like symtpoms” beset residents as soon as it gets cold and gas heaters are turned on. The CDC, the news media, public service announcements all warn that CO poisoning is the most common missed ER diagnosis, because CO poisoning mimics the flu, allergies, a cold…causes headaches, malaise and elevated body temperature. Some studies have suggested more than half of “flu” Dx in cooler months are, in fact, CO poisonings. CO poisoning often “resolves” in the wait for ER attention: Carboxyhemoglobin’s half life is only a few hours.

And before you whinge about the impracticality of running a carboxyhemoglobin blood test on every fluish patient, please remember there are now portable pulse spectrometers that can distinguish serum Osat from carboxyhemoglobin saturations. Your hospital probably has one. If it doesn’t, go straight to risk management and demand one. Sound like too much trouble for a pain in the ass subset of patients? You might want to consider the cost-benefit analysis of a $45 blood test versus a malpractice suit for failure to Dx.

And yet, I think I still hear the resentful teeth-grinding of ignorant curmudgeons. Still, there is NO EXCUSE for missing a CO poisoning. Even without a portable COhb enabled P-spect, even before the bloodtest(which ought to be routine during winter months in cold climates) comes back, ONE SIMPLE HISTORY QUESTION CAN SAVE YOUR ASS AND SPARE YOUR PATIENT A WORLD OF HURT:

“Have you recently turned on or started using a different gas heater/ woodstove/ fireplace/ boiler/ old water heater/unvented gas cooking stove?”

Are you really to busy to ask that one question? Or is it that you’ve become so hardened to ignorance you fail to recognize it in yourself?

And why should you “be nice” to “difficult patients” like me? After all, haven’t you been taught that we’re litigious, and that your chances of being sued increase with contact time? Maybe. And maybe not. The prestigious teaching hospital failed me, and the attending missed my Dx. I suffered substantial harm as a result. But because the attending treated me with respect and kindness, I could not fault him for his mistake and have no desire to litigate.

Believe it or not, I actually do know how hard your job is even without “difficult” patients like me. Indeed, the reason I and others like me often give you too much, largely irrelevant information is because WE WANT TO HELP YOU HELP US.

And in case you’re wondering: When you took your CPx to get your license, your “history” segment was one I helped beta-test and standardize during the initial development of the CPx. To be a doctor, you must have credentials. But it is seeming to me that increasingly, to be a “successful” patient one must be bland as store-bought pudding.

Hippocrates has left the building–but wasn’t that Freud I saw in the lounge?

By: Alyssa

Alyssa — Thu, 07 Feb 2013 04:14:26 +0000

So I care for a little one, I’m the nanny, anyway…the boys that I watch have a body temp of 97.4 when they are healthy. I’ve checked, many times while they are healthy. The mom is the same way. Anyway for the last 4+ months now, the baby, who is 16months has had fevers, almost daily…they usually brake with “Tylenol” and run from 99.4 (according to you not a fever) to 102. A few times 103 to 104. He has also been exteamly fussy these past months, and has at least 3+ movements of diarrhea per day. His doctor says not to worry unless he has like 5+ movements a day. He’s just not himself. His appetite comes and goes. I know that’s normal but this isn’t. I know you can’t diagnose, but does this sound like anything..? At what point do we take him back to the doctor?

By: AA Surgeon

AA Surgeon — Fri, 01 Feb 2013 20:02:14 +0000

First World Problem. Be thankful for the compassionate parents that bring in a child for a “low grade temp” instead of the ones whose neighbors have to bring in their battered children.

By: Victoria

Victoria — Tue, 29 Jan 2013 07:39:42 +0000

OP
Who the hell are you? You sound like an imbecile. Is this post supposed to be amusing? You seem hung up on semantics. You may not like referring to a borderline fever as “low grade” but it is a valid way to describe it. Also, as the first commenter said, there are physicians out there who will consider a 37.7 temperature to be above normal. But even if you don’t, it strikes me as ridiculous that you would waste time ranting about concerned parents. It seems that someone wants (needs?) to feel important. Were you not given enough attention growing up?

By: Concernedmother

Concernedmother — Fri, 19 Oct 2012 13:20:34 +0000

When you have a child with a fever that pretty much does not break down regardless of following the instructions (Tylenol every 4 hr), crying with headache, tummy ache, does not want to eat anything, lost almost 10lbs in 5 days, what a mother should do then? I have insurance and not on Medicaid. I don’t think it is any doctor’s business for being cautious with my child. You are getting paid so what do you care how frantic a parent feels. Doctors attend medical school to put parents and children’s mind at ease and to get paid comfortably. But I may be wrong. Maybe their main focus is the almighty dollars. Those same doctors are the ones who will quickly contact child services to state that the parent was negligent and if he or she had reached out immediate medical attention, this or that would not happen. So you know what, maybe some of the doctors in here chose the wrong profession and need to return to school for something else. This is a person-approach type of career just like Sales or Customer Service. If you (doctors) are grouchy all the times and start taking everything personal, then you will always need to post frustrating comments in similar sites to release your nerves. So chill and do your JOB!!!!

By: pet peeve list

pet peeve list — Sun, 18 Sep 2011 13:27:41 +0000

pet peeve…

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By: abi

abi — Fri, 24 Sep 2010 16:42:48 +0000

in no way do i find that a fair statement. i am a mother on medicaid. i dont rush my son in for everything because its free. i took ny son to the er last night because his fever kept spiking to 104.4 despite the tylenol and motrin i had been rotating in four hour intervals. you must be the kind of know it all nasty nurse i put in there place last night. i am finishing my training as an ma now so im not an idiot, im just poor hence the medicaid. i would suggest if ypu dont enjoy working with cranky people without adopting there attitude, you should probably find another career.

By: Stalwart Hospitalist

Stalwart Hospitalist — Fri, 10 Sep 2010 17:42:48 +0000

“Low grade speeding.”

HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA!

By: jb

jb — Thu, 09 Sep 2010 19:12:06 +0000

Of course, the urgency in which moms think their child needs immediate medical attention is directly correlated to whether or not they are on medicaid. It is only going to get worse now that more people are about to get “free” care…

By: Blacksails

Blacksails — Thu, 09 Sep 2010 06:21:03 +0000

Nurse K, when are you going to reopen your blog?