I. Measurement of body temperature
1.What factors will affect the measurement of body temperature?
A: Whether the body produces more heat or dissipates heat poorly, it can cause the body temperature to rise, such as drinking a lot of hot water, exercising, sauna, prolonged sun exposure, wearing too much clothing, etc. If you want to determine whether you are sick or not, you must avoid these factors and sit down for 15 to 30 minutes before taking your temperature. If you want to make sure that you are not sick and have a fever, you must avoid these factors and take your temperature after 15 to 30 minutes of resting.
2.What are the benefits of electronic thermometers compared to traditional mercury thermometers? Is the measurement accurate?
A: If regularly calibrated, the temperature measured by an electronic thermometer is no different from that of a mercury thermometer. But mercury thermometers are not suitable for general household use, mainly because of the risk of mercury poisoning and environmental pollution caused by the accidental breakage of mercury thermometers. Currently, Taiwan has stopped using mercury thermometers to reduce accidental injuries and environmental pollution.
3.How long does it take to measure body temperature with a thermometer?
A: The general electronic thermometer will beep about 1 minute after starting, and then you can read the temperature. Experts recommend that at least 2 to 5 minutes for oral temperature, 3 to 10 minutes for axillary temperature, and 1 to 3 minutes for anal temperature.
4.Is it accurate to feel a child’s skin to see if there is a fever?
A: The method of feeling the skin to determine if a child has a fever is very inaccurate, so when a child is sick, a thermometer must be used to correctly determine if the child has a fever. According to foreign studies, mothers can only correctly determine 74% of children with fever by hand, while the correct rate of nursing staff is only 42%.
5.There are many different ways to take a child’s temperature, which one is more accurate?
A: The methods of taking body temperature include anal temperature, oral temperature, axillary temperature, back temperature, ear temperature, forehead temperature, etc. Among them, the anal temperature is the closest to the real internal temperature of the body. Ear temperature is highly correlated with anal temperature and can replace anal temperature when necessary, but it must be noted that ear temperature of infants under three months of age is less correlated with central body temperature. Oral temperature is on average 0.5 °C lower than anal temperature, and axillary temperature is on average 0.8 °C lower than anal temperature, and oral and axillary temperatures are more likely to be affected by factors such as vasoconstriction of the skin and mucous membranes and to be low. For newborns under one month old or with low body weight, it is not suitable to measure anal temperature and ear temperature, and axillary temperature or back temperature can be considered. Use forehead temperature gun or infrared measurement of the skin surface, the accuracy is poor.
6.What is the correct way to measure anal temperature?
A: Wash the thermometer with soapy water or alcohol, rinse it with cold water (do not use hot water), and rub a little Vaseline and other lubricants on the end. The best position is to place the child in a prone position with the abdomen facing down and place the child on an adult’s lap or bed, holding the child’s lower back above the buttocks with one hand, and inserting the thermometer with the other hand about 1.5 to 2.5 cm deep from the anal opening. The electronic thermometer will be read by beeping after sitting for about 1 minute.
7.What do I need to pay attention to when measuring the oral temperature?
A: Children over 5 years old can use this method to measure their body temperature. It is not advisable to drink hot or cold water for 15 to 30 minutes before measurement to avoid measurement errors. Wash the thermometer with soapy water or alcohol and rinse with cold water (do not use hot water). Turn on the electronic thermometer switch, place the induction end under the child’s tongue, and leave it for about 1 minute, after the thermometer beeps, it can be read.
8.What do I need to pay attention to when measuring ear temperature?
A: The accuracy of the thermometer is poor for infants under 3 months old. When measuring the temperature, you must pay attention to the correct angle of the ear temperature gun inside the ear, as too much ear wax will interfere with the measurement. If you have otitis media or other middle ear abnormalities, your ear temperature may be inaccurate and you should use other methods to take your temperature. The ear temperature gun must be calibrated regularly to avoid loss of accuracy. When measuring, place the sensor end of the ear thermometer into the external ear canal and press the activation button to read the data within a few seconds. When the temperature of the two ears is different, the higher temperature should prevail.
Second, the meaning of fever
1.How many degrees above the body temperature is considered fever?
A: A fever is defined as a central body temperature ≥ 38°C. A body temperature between 37.5°C and 38°C may be normal or may be a low grade fever.
2.Why do people have fever?
A: There is a thermoregulatory center in the inferior colliculus of the human brain, in which e will set a temperature locating point, and the body temperature is usually set at about 37℃ when you are not sick. When the human body has an inflammatory reaction due to various diseases such as infection, some small molecules produced by the inflammatory reaction will act on the thermoregulatory center and cause the body temperature locus to rise, so the human body will carry out many physiological reactions and make the body temperature rise. There is another situation where the body is not inflamed and the temperature locus does not rise, but the body temperature rises because there is too much heat in the body to dissipate.
3.Why do children have cold hands and feet when they have fever?
A: When the inflammatory reaction causes the temperature locus of the inferior optic thalamus to rise, the normal body temperature recognized by the brain will exceed 38℃. If the body temperature does not reach the set standard at that time, the patient will feel cold (chills) and may involuntarily develop muscle tremors (chills) to increase heat and vasoconstriction of the extremities to reduce heat loss, so the phenomenon of cold hands and feet will occur.
4.Is there any benefit of fever to human body?
A: Many studies have shown that moderate fever can enhance the effectiveness of the immune system, but there are also studies showing that antipyretic drugs can suppress the immune response, so in animal experiments with a large number of antipyretic drugs will increase the mortality rate of sepsis. When humans are sick, fever is considered a protective instinctive response, aimed at strengthening our resistance to disease.
5.Is there any bad effect of fever on human body?
A: Fever requires excess heat production, so it increases oxygen consumption, carbon dioxide production and cardiac output. These effects are limited in healthy children, but children with severe heart disease, severe anemia, chronic lung disease, diabetes and inborn metabolic abnormalities may not be able to withstand these excess burdens. In addition, some children may suffer from fever and febrile convulsions between the ages of 6 months and 6 years due to physical factors.
6.Will a fever burn the brain?
A: Fever below 41℃ will not cause direct damage to the patient’s brain or other organs, but extremely high fever can sometimes cause abnormalities of varying degrees of consciousness. Generally speaking, the legendary cases of fever burning children’s brains are due to those children suffering from encephalitis, meningitis and other diseases, and fever is only one of the symptoms of these diseases, but what really affects the brain is a serious infection of the brain.
7.If there is still fever after using antipyretic medicine, does it mean that the antipyretic medicine prescribed by the doctor is not effective?
A: Some people think that if the fever rises again after taking antipyretic medicine, it means that the medicine prescribed by the doctor is not effective, so they will go to other doctors, resulting in a waste of medical treatment. In fact, fever is one of the phenomena that occurs after illness, and many diseases can cause fever.
The effect of all kinds of antipyretic drugs only lasts for a few hours, and their use is aimed at bringing short-lived comfort to small children. Most common respiratory or gastrointestinal viral infections have no specific medication, and some of them may last for a week or more. Fever is an important indicator of a changing disease process, and blindly reducing fever can create a false impression that may lead to misdiagnosis. If the fever does not go down, it is important to continue to seek medical attention to find out if there are other specific causes of the disease, rather than blaming the prescribed fever-reducing medication for being ineffective.
Three, the method of reducing fever
1.Since fever can enhance the effectiveness of the immune system, do not even reduce fever?
A: If the cause of the rise in body temperature is not inflammatory disease, then this high body temperature does not help the body and can be reduced at any time, such as too much clothing, heat stroke and other high body temperature. As for fever caused by inflammatory reactions, if the body temperature is not too high and does not cause special discomfort, there is no need to actively reduce the fever, especially if the body temperature does not exceed 39°C. Experts recommend that the following situations are more likely to be associated with fever-related discomfort, so consider reducing the fever when the temperature exceeds 38°C.
Chronic lung disease, adult-onset respiratory distress syndrome
Heart disease with heart failure or cyanotic heart disease
Chronic anemia
Diabetes mellitus and other metabolic abnormalities
Patients with previous febrile seizures or seizure history
Pregnant women
Other fever and discomfort symptoms
2.Which of the various fever-reducing methods, such as ice pillows, cooling patches and fever-reducing medicine, is more effective?
A: In the past, alcohol baths were used, because the rapid evaporation of alcohol will cause rapid contraction of blood vessels on the surface, and alcohol, if inadvertently let children inhale will have the risk of poisoning, but rather hinder the heat, so should not be used to reduce fever, other fever reduction methods can be divided into physical fever reduction methods (including ice pillows, low temperature blankets, heat dissipation patches on the skin surface, warm water swabbing bath) and drug fever reduction methods (including oral, anal plugs, injection of antipyretic drugs). Injections of antipyretic drugs) two kinds.
Ice pillows and other physical methods of fever reduction can only accelerate heat dissipation, and will not correct the abnormal rise in the localization of brain temperature caused by inflammatory reactions. This is like saying that when we have a fever, our brain will think that 38℃ or higher is the normal body temperature. Physical fever-reducing methods such as ice pillows defy the brain’s setting and allow heat loss, which is like setting the temperature of a water heater at 100℃ and plugging in the electricity to heat it up while throwing ice cubes in. Therefore, physical fever reduction methods such as ice pillows should not be used for inflammatory diseases, but rather fever-reducing drugs that can correct the localization point of the brain temperature.
For patients with metabolic diseases, chronic heart and lung diseases, chronic anemia, etc., who cannot cope with the sudden increase in energy demand, which may lead to the collapse of metabolic mechanisms or heart and lung failure, the risk of using ice pillows is even higher in such patients with fever. In cases of high body temperature, such as too much clothing, heat stroke, etc., the brain temperature locus is normal and only heat production and heat dissipation are out of balance, and only then can physical fever reduction methods be used.
3.Is there any fever-reducing effect by injecting drip or drinking a lot of water?
A: The injection or drinking water will only increase the water in the body, and has no effect on reducing fever caused by inflammatory diseases. When reducing fever, the body must sweat to dissipate excess heat in the body, so if the fever and fever reduction process is repeated too many times, it is easy to cause dehydration because of the large amount of sweating, and only then need to pay special attention to the appropriate replenishment of water and electrolytes.
4.Is there any fever-reducing medicine that should not be used by children?
A: The use of aspirin in children may damage the liver and brain and lead to Reye’s syndrome, so aspirin should not be used as a fever reducer in children under 18. Since the main chemical structure of aspirin is salicylic acid, other fever-reducing drugs containing salicylic acid should not be used in children under 18 years of age, including various oral or injectable fever-reducing drugs containing salicylic acid. The injectable antipyretics currently available in Taiwan, all of which have salicylic acid as their main ingredient, should not be used in children under the age of 18. In addition, pyrazolone derivatives such as dipyrone (anandamide) and phenylbutazone (botrytisone) may cause fatal white blood cell hypoglycemia, and their use is prohibited at all ages.
5.What kind of fever reducer is better for children?
A: Currently, the fever-reducing drugs available for children in Taiwan include acetaminophen, ibuprofen, diclofenac, etc. The duration of action and fever-reducing effect of these drugs are similar, and the main difference is the type of side effects they may cause. The use of these antipyretic drugs must be careful dosage, any kind of antipyretic drug overdose is not safe.
6.Is there any difference between oral and anal fever reducers?
A: There is no significant difference in the duration of action and fever-reducing effect between oral and anal medications, but it is recommended that children should use oral preparations as a priority. Anal plugs should only be considered if there is severe vomiting or if the child refuses to take the medication. There is no theoretical basis for the belief that oral or anal fever reducers should be used only when the body temperature reaches a certain level or higher.
7. What should I be aware of when using acetaminophen as a fever reducer?
A: The recommended dosage of acetaminophen for children is 10-15 mg per kilogram of body weight orally every 4 to 6 hours. The dosage of acetaminophen for children is very different from that of the adult form, so it is important to pay attention to the label and avoid overdose. The lowest single toxic dose is 120-150 mg/kg body weight. In addition, there is a risk of kidney damage with prolonged use of this drug. This agent has no gastrointestinal, coagulation and suppression of immune response side effects, so it is recommended that the following patients be given priority consideration for this drug.
Abnormal blood clotting and other bleeding tendencies
Upper gastrointestinal disorders such as peptic ulcer or gastrointestinal bleeding
Patients who have undergone surgery or have visible wounds for other reasons
Severe infections
8.What do I need to pay attention to when using ibuprofen as an antipyretic?
A: The recommended dosage of ibuprofen for children is 5 to 10 mg per kg of body weight orally every 6 to 8 hours. This drug is a non-steroidal inflammation inhibitor and is commonly used in China in the form of oral syrup. Possible side effects include stomach upset, upper gastrointestinal bleeding, reduced kidney blood flow, and inhibition of platelet coagulation.
9.What should I pay attention to when using diclofenac sodium as an antipyretic?
A: Diclofenac sodium is also a non-steroidal inflammation inhibitor and is commonly used in China in the form of plugs.
10.Can more than two fever-reducing drugs be used in rotation?
A: Considering that the effect of one antipyretic may be limited in a few cases of severe inflammation, the use of two antipyretics in rotation may be considered in special cases without violating the various antipyretic principles listed in this recommendation, but in principle, it is not recommended to give two or more antipyretics at the same time.
11.What do I need to pay attention to when using antipyretics for patients with G-6-PD deficiency (commonly known as “nematode disease”)?
A: Patients with this disorder may suffer from hemolytic anemia due to the destruction of red blood cells if they are exposed to highly oxidizing drugs. There is no significant risk of hemolytic anemia if acetaminophen and non-steroidal inflammatory inhibitors are used at the correct recommended doses. However, there is a risk of hemolysis when high doses of non-steroidal inflammatory suppressants are used for rheumatic diseases, such as aspirin at 80 mg/kg/day for Kawasaki disease.
Acetaminophen and ibuprofen are safe in children with G-6-PD deficiency at therapeutic doses, but should not be used in high doses, nor should aspirin, acetanilide, finasteride, aminopyrine, antabuse, or pautazone be used to reduce fever.