Temperature Spike 🌡️
Clinical guide for managing temperature spikes and fever in hospital patients. Quick-reference for on-call scenarios, sepsis assessment, and fever management for NCHDs.
🧠 Definition
- A temperature spike is a sudden elevation in body temperature, typically >38°C.
- It may signal infection, inflammation, or another systemic process.
- Consider differential diagnoses like sepsis, drug reactions, or malignancy.
📞 What to Ask / Orders to Make
- Current temp, timing of spike, rigors or chills?
- Review vitals (esp. HR, BP, RR, SpO₂)
- Has paracetamol been given?
- Any lines, catheters, wounds, recent surgery?
- Baseline cognition and mental status
- Ask nurse to prep for septic screen, cultures, and IV access
🧾 History
- Onset and duration of fever
- Associated symptoms: cough, dysuria, confusion, pain
- Recent procedures or devices (e.g. lines, IDC)
- Any recent antibiotics or immunosuppression?
- Review primary-team notes for context and plans
- Recent blood cultures or imaging?
🩺 Examination
- Full set of vitals: HR, BP, Temp, RR, SpO₂
- Check for source: chest, abdo, wounds, line sites, joints
- Neuro: confusion, new focal signs?
- Check for fluid status and perfusion (CRT, urine output)
🔍 Investigations
- Septic screen: Blood cultures, urine dip/culture, CXR, swabs
- Bloods: FBC, CRP, U&Es, LFTs, lactate
- ABG if unwell or desaturating
- Consider ECG if tachycardic or older pt
💊 Initial Management
- Start empirical IV antibiotics as per local policy
- Administer antipyretics (paracetamol if not yet given)
- IV fluids if hypotensive or dehydrated
- Monitor response: vitals, urine output, mental status
- Escalate if meets sepsis criteria or unstable
🔗 External Resources
HSE Adult Sepsis Screening Tool
Acute hospitals · Non-maternity · ≥16 yrs · Educational aid — does not replace clinical judgement.
Confirmed or suspected infection?
A-F Assessment
Systematic approach to patient assessment
| Step | Assessment | What to Look For |
|---|---|---|
| A – Airway | Is the patient talking? Any stridor or obstruction? | Noisy breathing, choking, gurgling, stridor |
| B – Breathing | Check RR, SpO₂, listen to chest | Tachypnoea, crepitations, wheeze, low sats |
| C – Circulation | Pulse, BP, CRT, temperature, IV site | Hypotension, tachycardia, delayed CRT, red IV site |
| D – Disability | Assess GCS or AVPU | Confusion, reduced consciousness, new neuro deficit |
| E – Exposure | Inspect skin, temp, rashes, surgical sites | Cellulitis, petechiae, wound infection |
| F – Fluids | Fluid balance chart, urine output | Oliguria, signs of dehydration, fluid overload |
A – Airway
Assessment:Is the patient talking? Any stridor or obstruction?
Signs to Look For:Noisy breathing, choking, gurgling, stridor
B – Breathing
Assessment:Check RR, SpO₂, listen to chest
Signs to Look For:Tachypnoea, crepitations, wheeze, low sats
C – Circulation
Assessment:Pulse, BP, CRT, temperature, IV site
Signs to Look For:Hypotension, tachycardia, delayed CRT, red IV site
D – Disability
Assessment:Assess GCS or AVPU
Signs to Look For:Confusion, reduced consciousness, new neuro deficit
E – Exposure
Assessment:Inspect skin, temp, rashes, surgical sites
Signs to Look For:Cellulitis, petechiae, wound infection
F – Fluids
Assessment:Fluid balance chart, urine output
Signs to Look For:Oliguria, signs of dehydration, fluid overload
Note Template
Ready-to-use clinical note structure
🕒 26 / 05 / 2026 — 10:13 ATRP re: temp spike Patient: [age] [sex] Admission Dx: [reason for admission] PMHx: [relevant background] 🧾 Hx: • Fever: [temp / rigors / chills / timing] • Symptoms: [cough, dysuria, line site, confusion] • Devices: [line / catheter] • Recent procedures? 🩺 Exam: • Vitals: HR __ BP __ Temp __ RR __ SpO₂ __ • Chest exam / abdomen / line sites / wound / neuro 📋 Impression: Likely source: [chest / urine / line / unclear] 📌 Plan: • Blood cultures ± urine / swab / CXR • Start empiric abx • IV fluids if needed • Monitor + escalation plan • Consider Sepsis 6 if indicated 👤 [Your Name], [Role] IMC: _______