Emergency care for fever. Medical tactics for acute fever Emergency care for a febrile state


Dashevskaya N.D. State Educational Institution of Higher Professional Education "Ural State Medical Academy" -,Department of Pediatrics FPC and PP, Roszdrav, Ekaterinburg

Definition: Fever (K ​​50.9) is a protective-adaptive reaction of the body that occurs in response to exposure to pathogenic stimuli and is characterized by a restructuring of thermoregulation processes, leading to an increase in body temperature, stimulating the natural reactivity of the body.

Fever continues to be one of the common reasons for seeking emergency care in pediatric practice. Fever worsens the child's condition and worries parents, and remains the main reason for the uncontrolled use of various medications. 95% of ARVI patients receive antipyretic drugs at temperatures below 38°C, although in most children moderate fever (up to 38.5°C) does not cause serious discomfort.

  1. Infectious origin - occurs frequently and develops due to exposure to pyrogens of a viral or bacterial nature
  2. Non-infectious origin (central, psychogenic, reflex, endocrine, resorption, medicinal origin.

Classification:

Depending on the degree of increase in axillary temperature:

Subfebrile 37.2-38.0 C.

  • Low febrile 38.1-39.0 C.
  • High febrile 39.1-40.1 C.
  • Excessive (hyperthermic) over 40.1 C.

Clinical options:

  • “Red” (“pink”) fever (accompanied by normal health and pink skin)
  • “White” (“pale”) fever (a disturbance in well-being and condition is noted, Chills, -a; m. A painful sensation of cold, often accompanied by muscle tremors of the body, caused by spasm of the blood vessels in a person, for example, during fever or any injury .

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  • Hyperthermic syndrome (an extremely serious condition caused by pale fever in combination with toxic damage to the central nervous system)

Reducing the temperature is necessary in the following cases:

  • in children under 6 months. at body temperature more than 38.0 C;
  • in children from 6 months to 6 years with a sudden increase in temperature over 39.0 ° C;
  • in children with heart and lung diseases, potentially dangerous for the development of acute cardiac and respiratory failure, in children with convulsive syndrome (of any etiology), as well as for diseases of the central nervous system, potentially dangerous for the development of this syndrome, at a temperature of 38.0 "C and above;
  • all cases of pale fever at a temperature of 38.0 C or more.

Temperature reduction tactics:

  1. Should not be used for any temperature reaction;
  2. It is not necessary to achieve normalization of temperature; in most cases, it is enough to lower body temperature by 1-1.5 ° C, which is accompanied by an improvement in the child’s well-being; The decrease in temperature should not be rapid;
  3. Antipyretic drugs should not be prescribed for regular course use and for children receiving Antibiotics - chemical substances produced by microorganisms or their structural analogues, which even in very small concentrations have a detrimental effect on other microorganisms or tumor cells.

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Choice of antipyretic agent:

It is recommended to use only the following as antipyretic drugs in children:

Paracetamol(panadol, calpol, efferalgan) in children after the 1st month of life in a single dose of 15 mg/kg, daily dose of 60 mg/kg.

Analgin(metamizole) is prescribed only in emergency cases parenterally (0.1-0.2 ml of 50% solution per 10 kg of body weight intramuscularly only).

Aspirin, analgin (orally), and nimesulide (Nise) should not be prescribed.

Emergency care for pink fever.

  • - paracetamol orally in a single dose of 10-15 mg/kg.
  • - physical methods of cooling: expose the child as much as possible, provide access to fresh air, wipe with a damp swab at a water temperature of at least 37.0 °C, let the child dry, repeat the procedure 2-3 times with an interval of 10-15 minutes, blow with a fan, use a cool wet bandage on the forehead, cold on the area of ​​large vessels;
  • - intramuscular administration of antipyretic drugs, if the desired result cannot be achieved within 30 minutes: 50% solution of metamizole sodium (analgin) 0.01 ml/kg for children of the first year of life, over one year of age - 0.1 ml/year. Antihistamines are prescribed only when indicated.
  • - continue physical cooling methods if necessary.

Emergency care for “pale” fever.

  • - paracetamol or ibuprofen orally in a single dose.
  • - papaverine dihydrochloride or rotaverine hydrochloride (no-spa) in an age-related dosage (papaverine dihydrochloride 2% - up to one year
  • - 0.1-0.2 ml, over 1 year - 0.2 ml/year of life, no-spa 0.05 ml/kg
    V/).
  • - Rubbing, -i; Wed 1. Movements (of palms, towels, etc.) on the surface of the skin, made with the aim of causing a rush of blood or causing smth. absorb into the skin; one AND massage techniques. Options: straight, zigzag, spiral and circular rubbing using fingertips; possible straight-line rubbing using the palm and the tubercle of the thumb; forceps (with a pinch or three fingers); comb-shaped with fingers clenched into a fist, etc. 2. A substance (ointment, gel, tincture) that is rubbed into the skin (usually for medicinal or cosmetic purposes).

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  • - if the desired result cannot be achieved within 30 minutes, intramuscular administration of antipyretic drugs: 50% solution of metamizole sodium (analgin) 0.01 ml/kg for children of the first year of life, over one year of age - 0.1 ml/year in combination with clemastine (suprastin) 2%
  • - 0.1-0.15 ml per 1 year of life, but not more than 1.0 ml and papaverine dihydrochloride 2% - up to one year - 0.1-0.2 ml, over 1 year - 0.2 ml/year life.
  • - if there is no effect within 30 minutes. - intravenous droperidol 0.25% - 0.1 ml/kg.

Fever is a general adaptive reaction of the body to exposure to an infectious agent, which is a change in thermal regulation with the accumulation of heat and an increase in body temperature.


As you know, an INCREASE in body temperature by 1°C speeds up the heart rate by 10 beats.
BREATHING during fever increases in parallel with an increase in heart rate and body temperature.
Since temperature reflects the degree of reactivity of the diseased organism, it can be a valuable indicator of its condition in the fight against infection.
There are THREE stages of most fevers, and the amount of patient care depends on each STAGE of the fever.

Stage 1— INCREASE in temperature (short-term), characterized by a PREMIUM of heat production over heat transfer.
PREPARE:
- a heating pad,
- towel,
- one or two blankets.
- sippy cup,
- ship,
— mineral water (fruit drink, juices) without gases.

THE MAIN PROBLEM OF THE PATIENT IS CHILLS, pain throughout the body, headache, and there may be cyanosis (blueness) of the lips.

SEQUENCING:
1. Create peace, put him to bed, put a heating pad at his feet, cover him well, give him strong, freshly brewed tea.
2. Monitor physiological functions in bed.
3. DO NOT LEAVE THE PATIENT ALONE!
4. DO NOT ALLOW DRAFTS!
5. It is advisable to install an INDIVIDUAL POST. If this is not possible, then the nurse MUST frequently approach the patient and monitor hemodynamic indicators (pulse, blood pressure, heart rate, respiratory rate and blood flow rate. IF CHANGES APPEAR TO WORSE, she should IMMEDIATELY call a doctor!
The higher the temperature and the greater its fluctuations, the more exhausted the patient becomes. To increase the body's resistance and replenish energy losses, it is necessary to FEED the patient with HIGH-CALORIE and EASILY ABSOLUTE food in liquid or semi-liquid form, 5-6 times a day, NO MORE, in small portions. As a detoxification (reducing concentration) and removing toxic substances from the body, a large amount of liquid is used in the form of mineral water, juices, and fruit drinks.

Stage 2— MAXIMUM RISE in temperature (HEAT period).
PREPARE:
- ice pack,
- towel,
- tonometer with phonendoscope,
- sippy cup,
- ship.

SEQUENCING:
1. If possible, organize an individual post.
2. Inform the doctor about changes in the patient's condition.
3. Monitor hemodynamic parameters.
4. Remove blankets and cover the patient with a sheet.
5. Apply LOTS to the peripheral vessels and an ice pack to the head.
6. Ventilate the room, avoid drafts.
7. Take care of the patient’s mouth, nose and other organs.
8. Help the patient with physiological functions, prevent pressure sores.

Stage 3- period of temperature REDUCTION.
It can proceed in different ways, since the temperature can decrease CRITICALLY, that is, SHARPLY decrease from HIGH numbers to LOW (for example, from 40 to 37 degrees), which is often accompanied by a RAPID drop in vascular tone, which manifests itself in a SHARP decrease in blood pressure to 80/ 20 mmHg Art. and the appearance of a THREADY pulse, increased sweating (hyperhidrosis), extreme weakness, PALNESS of the skin.
This patient's condition is called collapse and requires URGENT measures from medical personnel.
A GRADUAL REDUCTION in temperature from high numbers to normal (below normal) is called LYTIC temperature decrease (lysis).


Latest materials in this section.

Fever- one of the common symptoms of many childhood diseases. This is explained by the fact that an increase in body temperature is a protective reaction of the body that occurs in response to exposure to pyrogenic stimuli.

Due to the widespread availability of antipyretic drugs, doctors are increasingly faced with problems such as uncontrolled use of drugs, overdose, complications and side effects, which cannot but affect the health of children.

Therefore, it is very important to understand what a fever is and in which cases it is necessary to prescribe antipyretics, and in which cases you can do without them.

Normal temperature body temperature is considered to be in the range of 36.4 -37.4 degrees (when measured in the armpit). In the morning hours the temperature is slightly lower, the highest in the evening hours (these are daily temperature fluctuations, if they are within 0.5 - 1 degree - this is normal).

If body temperature in the armpit above 37.4 degrees, then they are already talking about an increase in body temperature. (in the oral cavity above 37.6°C; rectal - above 38°C)

Causes of fever

Infectious diseases are one of the most common causes of fever;

Fever of a non-infectious nature can be:

  • Central origin - as a result of damage to various parts of the central nervous system;
  • Psychogenic in nature - disorders of higher nervous activity (mental disorders, neurosis); emotional stress;
  • Endocrine origin - thyrotoxicosis, pheochromocytoma;
  • Medicinal origin - taking certain drugs (xanthine drugs, ephedrine, methylthionine chloride, some antibiotics, diphenine and others).

The most common cause of fever is infectious diseases and inflammation.

Types of fevers

By duration of fever:

  • Ephemeral - from several hours to several days;
  • Acute - up to 2 weeks;
  • Subacute - up to 6 weeks;
  • Chronic - more than 6 weeks.

According to the degree of increase in body temperature:

  • Subfebrile - up to 38°C;
  • Moderate (febrile) - up to 39°C;
  • High - up to 41°C;
  • Hyperthermic - over 41°C.

Also distinguish:

  • "Pink fever"
  • "Pale fever."

Clinical manifestations and symptoms of fever

It should be remembered that fever is a protective reaction of the body; it helps us fight the disease. Unreasonable suppression of fever can lead to a decrease in the intensity of the immune response and progression of the disease. At the same time, this is a nonspecific protective-adaptive reaction and, when compensatory mechanisms are depleted or in the hyperergic version, it can cause the development of pathological conditions such as hyperthermic syndrome.

In children with serious diseases of the cardiovascular, respiratory and nervous systems, fever can lead to decompensation of these systems and the development of seizures.

Therefore, a golden mean is necessary in everything, and if a child’s body temperature rises, a doctor’s consultation is required.

Fever is only one symptom, so it is very important to determine the cause that led to the increase in temperature. To do this, it is necessary to assess the magnitude of the rise in body temperature, its duration, fluctuations, and also compare the data with the child’s condition and other clinical manifestations of the disease. This will help make a diagnosis and choose the right treatment tactics.

Depending on the clinical manifestations, “pink fever” and “pale fever” are distinguished.

"Rose Fever"

With this type of fever, heat transfer corresponds to heat production; this is a relatively favorable course.

At the same time, the child’s general condition and well-being are not significantly affected. The skin is pink or moderately hyperemic in color, moist and warm (or hot) to the touch, the limbs are warm. The increase in heart rate corresponds to an increase in body temperature (for every degree above 37°C, shortness of breath increases by 4 breaths per minute, and tachycardia by 20 beats per minute).

"Pale (white) fever"

This type is said to occur when, with an increase in body temperature, heat transfer does not correspond to heat production, due to impaired peripheral circulation. The fever takes an unfavorable course.

In this case, the child experiences a disturbance in his condition and well-being, chills persist for a long time, pallor of the skin, acrocyanosis (blue around the mouth and nose), and “marbling” appear. There is a strong increase in heart rate (tachycardia) and breathing (shortness of breath). Extremities are cold to the touch. The child’s behavior is disturbed; he is lethargic, indifferent to everything, and may also experience agitation, delirium, and convulsions. Weak effect of antipyretics.

This type of fever requires emergency care.

Hyperthermia syndrome also requires emergency care, especially in young children. With hyperthermic syndrome, decompensation (exhaustion) of thermoregulation occurs with a sharp increase in heat production, inadequately reduced heat transfer and lack of effect from antipyretic drugs. It is characterized by a rapid and inadequate increase in body temperature, which is accompanied by impaired microcirculation, metabolic disorders, and dysfunction of vital organs and systems.

Treatment of fever

When body temperature rises, the question immediately arises: Do I need to lower the temperature?

According to the recommendations of the World Health Organization, antipyretic therapy for initially healthy children should be carried out when body temperature rises above 38.5°C. But, if a child has a fever (regardless of the severity of the temperature increase), there is a deterioration in the condition, prolonged chills persist, myalgia, poor health, pallor of the skin, and manifestations of toxicosis appear, then antipyretic therapy should be prescribed immediately.

It should be noted that for children at risk of developing complications due to an increase in body temperature, antipyretic therapy is prescribed at lower levels. For “red fever” at a temperature above 38°C, for “white” fever - even at low-grade fever (above 37.5°C).

The risk group includes:

  • Children in the first three months of life;
  • Children with a history of febrile seizures - that is, those who have previously had seizures against the background of an increase in body temperature;
  • With pathology of the central nervous system;
  • With chronic heart and lung diseases;
  • Children with hereditary metabolic diseases.

Urgent Care

For "red fever"

Open the child, expose him as much as possible and provide access to fresh air (avoiding drafts).

It is necessary to provide the child with plenty of fluids - 0.5-1 liter more than the age norm of fluid per day.

Antipyretic therapy should begin with physical cooling methods:

Cool wet bandage on forehead;

Cold (ice) on the area of ​​large vessels (armpits, groin area, neck vessels (carotid artery));

Vodka-vinegar rubdowns - mix vodka, 9% table vinegar and water in equal volumes (1:1:1). Wipe the child with a swab soaked in this solution and let it dry. It is recommended to repeat 2-3 times.

If there is no effect, move on to antipyretic drugs(orally or rectally).

For children, paracetamol is used (in syrup, tablets, suppositories - depending on age) in a single dosage of 10-15 mg per 1 kg of weight.

Ibuprofen is prescribed in a single dose of 5-10 mg per 1 kg of the child’s weight (read the instructions before use).

If the temperature does not decrease within 30-45 minutes, an antipyretic mixture may need to be administered intramuscularly (done by medical professionals).

For "white fever"

With this type of fever, simultaneously with antipyretics, it is also necessary to give vasodilators orally or intramuscularly (if possible). Vasodilators include: no-spa, papaverine (dosage 1 mg/kg orally).

Fever is one of the most common symptoms of infectious diseases in children and one of the most common reasons why parents seek help from a pediatrician. Fever is the most common reason for the use of medications.

When measuring body temperature in the armpit, a body temperature of 37.0°C or higher is usually considered elevated. However, it should be borne in mind that values ​​of 36.0-37.5 ° C can be considered normal. A child’s normal body temperature fluctuates during the day within the range of 0.5-1.0°C, increasing in the evening. Axillary temperature is 0.5-0.6°C lower than rectal temperature.

Fever is a nonspecific protective-adaptive reaction of the body that occurs in response to exposure to various pathogenic stimuli and is characterized by a restructuring of thermoregulation processes, which leads to an increase in body temperature.

Elevated body temperature reduces the viability of some pathogenic microorganisms and enhances the specific and nonspecific components of immunity. However, an increase in temperature can play an adaptive role only when it rises to a certain limit. With high hyperthermia (40-41°C), an increase in the intensity of metabolic processes is observed. Despite the increased work of the respiratory and cardiovascular systems (with an increase in body temperature by every degree above 37 ° C, the respiratory rate increases by 4 per 1 min, the heart rate (HR) increases by 10-20 per 1 min), increased oxygen delivery can fail to meet the growing tissue needs for it, which leads to the development of tissue hypoxia and disruption of the distribution of vascular tone. First of all, the functions of the central nervous system are affected, which is often manifested by the development of convulsive syndrome - febrile seizures (especially in young children with perinatal damage to the central nervous system). With hyperthermia, cerebral edema may develop, when the child’s condition sharply worsens and depression of the central nervous system occurs.

In children with malnutrition, respiratory failure, as well as with lesions of the central nervous system, adverse health consequences can develop with a relatively moderate degree of increase in body temperature (38.5-39°C).

Classification of fever

    By etiological factor:

    Infectious;

    Non-infectious;

    By duration:

    Ephemeral (up to several days);

    Acute (up to 2 weeks);

    Subacute (up to 6 weeks);

    Chronic (over 6 weeks);

    According to the presence of inflammation:

    Inflammatory;

    Non-inflammatory;

    By degree of temperature increase:

    Subfebrile (up to 38°C);

    Febrile (38.1-39°C);

    Febrile high (39.1-41°C);

    Hyperthermic (over 41°C).

Mechanism of fever

An increase in body temperature of infectious origin develops in response to exposure to pyrogens of a viral or bacterial nature and is most common.

Fever is based on the ability of granulocytes and macrophages to synthesize and release endogenous protein pyrogens, interleukins (IL-1, IL-6), tumor necrosis factor (TNF) and interferons when activated. The target for the action of endogenous pyrogens is the thermoregulatory center, which regulates the mechanisms of heat production and heat transfer, thereby ensuring normal body temperature and its daily fluctuations.

IL-1 is considered the main initiating mediator in the mechanism of fever development. It stimulates the secretion of prostaglandins, amyloids A and P, C-reactive protein, haptoglobin, a1-antitrypsin and ceruloplasmin. Under the influence of IL-1, the production of IL-2 by T lymphocytes is initiated and the expression of cellular Ig receptors increases, as well as the proliferation of B lymphocytes and stimulation of antibody secretion. Disruption of immune homeostasis during infectious inflammation ensures the penetration of IL-1 through the blood-brain barrier, where it interacts with receptors of neurons of the thermoregulation center. In this case, cyclooxygenase (COX) is activated, which leads to an increase in the intracellular level of cyclic adenosine-3,5-monophosphate (cAMP) and a change in the intracellular Na/Ca ratio. These processes underlie changes in the sensitivity of neurons and a shift in the thermoregulatory balance towards increased heat production and decreased heat transfer. A new, higher level of temperature homeostasis is established, which leads to an increase in body temperature.

The most favorable form of the body's reaction to infectious diseases is an increase in body temperature to 38.0-39 ° C, while its absence or febrile high fever indicates a reduced reactivity of the body and is an indicator of the severity of the disease. When fever develops during the day, the maximum increase in body temperature is recorded at 18-19 hours, the minimum level is in the early morning. Information about the characteristics and dynamics of fever throughout the course of the disease has important diagnostic value. For different diseases, febrile reactions can occur in different ways, which is reflected in the shapes of temperature curves.

Clinical variants of fever

When analyzing the temperature reaction, it is very important to evaluate not only the magnitude of its rise, duration and daily fluctuations, but also to compare these data with the condition and well-being of the child, and the clinical manifestations of the disease. This is necessary to select the correct treatment tactics for the patient, as well as to conduct further diagnostic searches.

First of all, it is necessary to assess the clinical signs of compliance of heat transfer processes with an increased level of heat production, because Depending on the individual characteristics of the body, fever, even with the same degree of increase in body temperature in children, can occur differently.

If the child responds adequately to an increase in body temperature, heat transfer corresponds to increased heat production, which is clinically manifested by normal health, pink or moderately hyperemic skin color, moist and warm to the touch (the so-called “pink fever”). Tachycardia and increased breathing correspond to the level of body temperature, the rectal-digital gradient does not exceed 5-6 °C. This type of fever is considered prognostically favorable.

If the child’s response to an increase in body temperature is inadequate and heat transfer is significantly less than heat production, then clinically there is a pronounced disturbance in the child’s condition and well-being, chills, pale, marbled skin, nail beds and lips with a cyanotic tint, cold feet and palms (the so-called “pale fever” ). There is persistent persistence of hyperthermia, excessive tachycardia, shortness of breath, possible delirium, convulsions, and a rectal-digital gradient of more than 6 °C. This course of fever is prognostically unfavorable and is a direct indication for emergency care.

Among the clinical variants of the pathological course of fever, hyperthermic syndrome is distinguished, in which there is a rapid and inadequate increase in body temperature, accompanied by impaired microcirculation, metabolic disorders and progressively increasing dysfunction of vital organs and systems. The risk of developing such conditions is especially high in young children, as well as those with a burdened premorbid background. The younger the child is, the more dangerous a rapid and significant rise in body temperature is for him due to the possible development of progressive metabolic disorders, cerebral edema, and impairment of vital functions. If a child has serious diseases of the cardiovascular and respiratory systems, fever can lead to the development of their decompensation. In children with pathologies of the central nervous system (perinatal encephalopathy, epilepsy, etc.), seizures may develop against the background of elevated body temperature.

Febrile seizures occur in 2-4% of children, most often at the age of 12-18 months. They usually occur with a rapid rise in temperature to 38-39 °C and higher at the very beginning of the disease. Repeated seizures can develop in a child at other temperatures. If a child experiences febrile seizures, it is necessary to first rule out meningitis. In infants with signs of rickets, a calcium level test is indicated to exclude spasmophilia. Electroencephalography is indicated after the first episode only for prolonged, repeated or focal seizures.

Tactics of management and treatment of children with fever

In case of febrile conditions in children, measures taken should include:

    Semi-bed or bed rest depending on the level of increase in body temperature and the child’s well-being;

    A gentle, dairy-vegetable diet, feeding depending on appetite. It is advisable to limit the intake of fresh milk due to possible hypolactasia at the height of the fever. Drink plenty of fluids (tea, fruit juice, compote, etc.) to ensure adequate heat transfer due to increased sweating.

Therapeutic tactics for increased body temperature depend on the clinical variant of the fever, the severity of the temperature reaction, and the presence or absence of risk factors for the development of complications.

The decrease in body temperature should not be critical; it is not necessary to achieve normal levels; it is enough to lower the temperature by 1-1.5°C. This leads to an improvement in the child’s well-being and allows him to better tolerate a feverish state.

In case of “pink fever”, it is necessary to undress the child, taking into account the air temperature in the room, put “cold” on large vessels (inguinal, axillary areas), if necessary, wipe with water at room temperature, which is sufficient to reduce body temperature or significantly reduces the amount of pharmacotherapy. Rubbing with cold water or vodka is not recommended, as it can lead to spasm of peripheral vessels and a decrease in heat transfer.

Indications for the use of antipyretic drugs. Considering the protective-adaptive mechanism of fever in children and its positive aspects, antipyretics should not be used for any temperature reaction. If the child does not have risk factors for developing complications of a febrile reaction (febrile convulsions, cerebral edema, etc.), there is no need to reduce body temperature below 38-38.5°C using antipyretic drugs. However, if, against the background of fever, regardless of its severity, there is a deterioration in the general condition and well-being of the child, chills, myalgia, pale skin, and other symptoms of toxicosis, antipyretics are prescribed immediately.

In children at risk with an unfavorable course of fever with severe intoxication, impaired peripheral circulation (“pale fever”), antipyretic drugs are prescribed even at low-grade fever (above 37.5 ° C), for “pink fever” - at a temperature exceeding 38, 0°C (Table 1).

Antipyretics are mandatory, along with other measures, for hyperthermic syndrome, when a rapid and inadequate increase in body temperature occurs, accompanied by impaired microcirculation, metabolic disorders and progressively increasing dysfunction of vital organs and systems.

It should be noted that medications to reduce fever should not be prescribed in a course, since this changes the temperature curve and makes the diagnosis of infectious diseases very difficult. The next dose of an antipyretic drug is needed only when the body temperature rises again to the appropriate level.

Principles for choosing antipyretic drugs in children. Antipyretics are most widely used in children compared to other drugs, so their choice is based primarily on safety rather than effectiveness. The drugs of choice for fever in children, according to WHO recommendations, are paracetamol and ibuprofen. Paracetamol and ibuprofen are approved in the Russian Federation for over-the-counter use and can be prescribed to children from the first months of life both in a hospital and at home.

It should be noted that paracetamol has an antipyretic, analgesic and very weak anti-inflammatory effect, because implements its mechanism primarily in the central nervous system and does not have a peripheral effect. Ibuprofen (Nurofen for children, Nurofen) has more pronounced antipyretic, analgesic and anti-inflammatory effects, which is determined by its peripheral and central mechanisms. In addition, the use of ibuprofen (Nurofen for children, Nurofen) is preferable if the child has a pain syndrome along with fever, for example, fever and sore throat with sore throat, fever and ear pain with otitis media, fever and joint pain with pseudotuberculosis, etc. The main problem when using paracetamol is the danger of overdose and associated hepatotoxicity in children over 10-12 years of age. This is due to the peculiarities of the metabolism of paracetamol in the child’s liver and the possibility of the formation of toxic metabolites of the drug. Ibuprofen can rarely cause undesirable effects from the gastrointestinal tract, respiratory system, extremely rarely from the kidneys, changes in the cellular composition of the blood.

However, with short-term use of recommended doses (Table 2), the drugs are well tolerated and do not cause complications. The overall incidence of adverse events associated with the use of paracetamol and ibuprofen as antipyretics is approximately the same (8-9%).

Prescription of Analgin (metamizole sodium) is possible only in case of intolerance to other antipyretic drugs or if parenteral administration is necessary. This is associated with the risk of adverse reactions such as anaphylactic shock, agranulocytosis (with a frequency of 1:500,000), prolonged collapsing state with hypothermia.

It should be remembered that drugs with a strong anti-inflammatory effect are more toxic. It is irrational to use powerful anti-inflammatory drugs - nimesulide, diclofenac - to reduce body temperature in children; they are approved only for prescription use.

Acetylsalicylic acid is not recommended as an antipyretic for children, as it can cause Reye's syndrome (severe encephalopathy with liver failure) in case of influenza and other acute respiratory viral infections and chicken pox. You should not use amidopyrine and phenacetin, which are excluded from the list of antipyretic drugs due to high toxicity (development of seizures, nephrotoxicity).

When choosing medications to reduce fever in children, it is necessary to take into account, along with safety, the convenience of their use, i.e., the availability of children's dosage forms (syrup, suspension), as well as cost.

Therapeutic tactics for various clinical types of fever in children. The choice of starting antipyretic drug is primarily determined by the clinical type of fever. If a child tolerates an increase in temperature well, his health suffers slightly, the skin is pink or moderately hyperemic, warm, moist (“pink fever”), the use of physical cooling methods allows one to reduce body temperature and, in some cases, avoid pharmacotherapy. When the effect of using physical methods is insufficient, paracetamol is prescribed in a single dose of 15 mg per kg of body weight or ibuprofen in a dose of 5-10 mg per kg of body weight taken orally in suspension (Nurofen for children) or tablet form (Nurofen) depending on age child.

For “pale fever,” antipyretics should be used only in combination with vasodilators. It is possible to use Papaverine, No-shpa, Dibazol. In case of persistent hyperthermia with a violation of the general condition, the presence of symptoms of toxicosis, there is a need for parenteral administration of vasodilators, antipyretics and antihistamines. In such cases, use a lytic mixture:

    2% Papaverine solution intramuscularly in a single dose of 0.1-0.2 ml for children under 1 year of age; 0.2 ml per year of life for children over one year of age;

    50% solution of Analgin (metamizole sodium) intramuscularly, in a single dose of 0.1-0.2 ml per 10 kg of body weight for children under 1 year of age; 0.1 ml per year of life for children over 1 year of age

    2.5% solution of Pipolfen (or Diprazine) intramuscularly in a single dose of 0.5 or 1.0 ml.

Children with intractable fever should be hospitalized.

Hyperthermic syndrome, in which there is a rapid and inadequate increase in body temperature, accompanied by impaired microcirculation, metabolic disorders and progressively increasing dysfunction of vital organs and systems, requires immediate parenteral administration of antipyretics, vasodilators, antihistamines, followed by hospitalization and emergency syndromic therapy.

Thus, when treating a child with fever, the pediatrician should remember:

    Antipyretic drugs should not be prescribed to all children with elevated body temperature; they are indicated only in cases of infectious-inflammatory fever when it has an adverse effect on the child’s condition and threatens the development of serious complications;

    Among antipyretic drugs, preference should be given to ibuprofen (Nurofen for children, Nurofen), which has the lowest risk of unwanted effects;

    The prescription of Analgin (metamizole sodium) is possible only in case of intolerance to other antipyretic drugs or if their parenteral administration is necessary.

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Fever is a protective-adaptive reaction of the body that occurs in response to the interaction of pathogenic stimuli and is characterized by a restructuring of thermoregulation processes, leading to an increase in body temperature; stimulation of the body's natural reactivity.

Fever continues to be one of the common reasons for seeking help in pediatric practice. Fever worsens the child's condition, causes concern for parents, and remains the main reason for the uncontrolled use of medications.

95% of patients with ARI receive antipyretic drugs at a body temperature of 38 C, although in most patients moderate fever up to 38.5 ° C does not cause serious discomfort.

Fever can develop against the background of infectious, infectious-allergic, and toxic-allergic processes, hypervitaminosis D, dehydration, as well as due to birth injuries, respiratory distress syndrome, etc.

In adults, fever can occur as a consequence of various brain pathologies (trauma, tumors, hemorrhage, etc.) during anesthesia.

A particularly dangerous condition is a critical increase in temperature to 40°C, in which hyperthermic syndrome develops, which is characterized by disruption of thermoregulation processes, hormonal and metabolic disturbances of heat production and disturbance of heat transfer. As a result, thermoregulation suffers: the body loses the ability to compensate for the rapid increase in heat production caused by the influence of exogenous (toxins) or endogenous (catecholamines, prostaglandins), pyrogenic substances, an increase in heat transfer, which worsens due to spasm of peripheral blood vessels.

Classification:

Depending on the degree of increase in axillary (axillary) body temperature, the following are distinguished:

  • Subfebrile 37.2° – 38.0° C;
  • Low febrile 38.1° – 39.0° C;
  • High febrile 39.1° – 40.0° C;
  • Excessive hyperthermic – more than 40.1°C.

Clinical options:

  • Red (“cart”) fever – accompanied by normal health and pink skin;
  • White (“pale”) fever – marked by poor health, chills, and pale skin;
  • Hyperthermic syndrome is an extremely serious condition, characterized by pale fever with toxic damage to the central nervous system.

Temperature reduction is necessary:

  • In children under 6 months. – at body temperature more than 38.0° C;
  • In children from 6 months. up to 6 years – with a sudden increase in temperature to 39° C;
  • In children with diseases of the cardiovascular system and respiratory systems, in children with convulsive syndrome - at a body temperature of 38.0 ° C and above;
  • All cases of pale fever with a body temperature of 38.0 ° C or more.

Tactics for reducing body temperature:

  1. You should not take antipyretics for any temperature reaction;
  2. It is not necessary to achieve normalization of the temperature; in most cases, it is enough to reduce the temperature by 1 - 1.5 ° C, which is accompanied by an improvement in the child’s well-being. The decrease in temperature should not be rapid.
  3. Antipyretics should not be prescribed as a regular course of treatment;
  4. Aspirin is prohibited in pediatric practice for children under 15 years of age, as it causes Reye's syndrome - life-threatening complications with damage to the child's liver and kidneys. In pediatric practice, paracetamol and ibuprofen are recommended.

On the other hand, paracetamol is also dangerous for an adult organism due to the fact that mature enzymes of the liver system, removing the drug, transform it into compounds toxic to the body, and children do not yet have these enzymes.

  1. Long-term use of antihistamines is also not recommended.

Emergency care for pink fever in children:

  • Paracetamol orally 10 mg/kg – single dose;
  • Physical cooling methods:

The child must be undressed, provided with access to fresh air, wiped with a damp swab at a water temperature of at least 37 ° C, let the child dry, repeat the procedure 2-3 times with an interval of 10-15 minutes; Blow with a fan, use a wet bandage on the forehead, axillary areas, cold on the area of ​​large vessels.

  • It is necessary to drink plenty of sweet warm tea with lemon, cranberry juice, juice, herbal decoctions of linden flowers, raspberries;
  • Feed the child in small portions in small quantities, with great emphasis on drinking plenty of fluids;
  • Intramuscular administration of antipyretics - if the desired result cannot be achieved within an hour. Antihistamine therapy only when indicated;
  • Continue physical cooling methods as needed;
  • See a doctor.

Emergency care for white fever:

  • Paracetamol and ibufen orally in single doses – 10 mg/kg;
  • Papaverine or noshpa in an age-appropriate dosage;
  • Rubbing the skin of the limbs and torso;
  • Applying a heating pad to the feet (heating pad temperature – 37° C);
  • If there is no antipyretic effect within 30 minutes, you should seek medical help.

Emergency care for hyperthermic syndrome:

  • Calling the resuscitation team;
  • Providing venous access, infusion therapy;
  • Hospitalization.

Pediatrician of the Krupskaya Central District Hospital L.V. Malinovskaya

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