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Paper Chase #2 - Nonspecific Symptoms and Infection in Older Patients in the ED

Tom Robertson, MD and Steve Biederman, MD
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To determine if nonspecific symptoms and fever affect probability of acute bacterial infection in older patients.

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Ian L., Dr -

Often the old elderly 80 years and over will not mount a fever as much -due to to waning immune responses .
So a temperature say one degree above their baseline will be significant .
Say if their baseline is 36.4 C then 37.3 or 37.4 C will be significant .
How you measure Temperature is contentious .
The tympanic thermometers will only be of some value if Tempratures are higher but not if temps are normal .
If the patient is cooperative oral temp is better but if unable to cooperate rectal temps are more accurate .
Other signs of Bacteremia - sepsis are a drop in blood pressure relative to the patients baseline increased respiratory rate above the patients baseline diminished muscle tone eg unable to sit up well or decreased movement ability .
Morandi A et al Diagnosis of Delirium superimposed on Dementia : J Am Med Dir Assoc. Jan 2016 and Tiegesz et al Am J Geriatric Psychiatry 2013 .

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Dude, Where's My DEA Number? Full episode audio for MD edition 195:47 min - 92 MB - M4AHippo Primary Care RAP - July 2019 Written Summary 518 KB - PDFHippo Primary Care RAP - July 2019 Written Summary 518 KB - PDF

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