【Major Point】

1. An ear temperature equal to or greater than 38℃ is considered a fever.
2. The use of ice pillows and cooling patches may hinder heat dissipation and is not recommended for regular use.
3. When experiencing a fever, the focus should be on improving comfort rather than aiming to reduce body temperature.
4. If fever is accompanied by changes in consciousness, difficulty breathing, persistent vomiting, inability to eat, or other conditions, seek medical attention immediately.
5. When seeking medical attention, proactively inform healthcare personnel about your travel history, occupational history, history of exposure to groups, and contact history.

What is a fever:
The normal body temperature ranged from 35.3℃ to 37.7℃. The body temperature will be different according to various measuring methods and some environmental factors. It is usually divided into core temperature and body surface temperature.

1. Core temperature: refers to the temperature measured from the inner parts of the body, usually rectal temperature or ear temperature. An ear temperature equal to or greater than 38℃ is considered a fever.
2. Body surface temperature: refers to the temperature of the skin that may not be accurate because it is easily affected by the environment (e.g. heat or cold). It is measured in the armpit or forehead temperature, which is suggested to be abnormal when it is over 37.5°C.

1. Infection: this is the most common cause of a fever (e.g. bacterial, viral, fungal, and parasitic infections.). From the immunology aspect, fever is a standard mechanism of protection to cope with infection. Therefore, it is crucial to treat the underlying condition instead of the fever itself.
2. Non-infection: fever causes by inflammation or immune response or heat damage and/or others.
   1. Inflammation: involves tissue damage by surgery, multiple trauma, fracture, etc.
   2. Immunoreaction: includes allergic reactions and autoimmunity, and/or other different causes may include vaccination, endocrine disorders, metabolic diseases, and vascular diseases.
   3. Heat-related illness: this happens when working or exercising under extremely hot weather for a period of time. A hyperthermia person should cool down their temperature and be treated immediately to prevent heat exhaustion. When heat exhaustion occurs without instant cooling or treatments can deteriorate into heat stroke, which can cause permanent damage to the central nervous system.
   4. Others: Acute pancreatitis, gout, and tumors, the fever pattern is usually low-grade fever (below or equal to 38.8 °C).
       

Common symptoms of fever:

1. The symptoms of infectious fever caused by bacterial or viruses are divided into three stages:
   1. Stage of onset of fever: Chillness (impulsive shivering to extremely muscle contraction), pale and cold skin, thirsty, increased breathing rate, increased heartbeat.
   2. Stage of extremely high temperature of fever: The body temperature reaches its highest level, skin flushing, heated skin, increasing heart rate, increasing breathing rate, thirstier, headache, decreased urine output, dehydration, dry and ruptured skin mucous membranes, general malaise and weakness, and poor appetite. Loss of consciousness and delirium may happen.
   3. Stage of remission of fever: Sweating, reduced chills and should be aware if dehydration happens at this stage.
2. When the progression of disease is ongoing, the body temperature can commonly return to normal than rise again. It will usually reaches the normal range within 2~3 days or 1 week. Some cases of viral infections may experience fever for up to a week or even longer period.
3. Those with following conditions should seek medical attention immediately:
   1. Infants under 3 months should seek medical consultation immediately when having a fever.
   2. Children having a fever for two days or temperature above 39˚C, and/or any other abnormal conditions (e.g. poor mobility or abnormal crying).
   3. Altered state of consciousness, lethargy, neck stiffness, complications with jerking movement, eye deviation/gazing, paralysis of the limbs, and abnormal sensation.
   4. Severe headache or sore throat, chest pain, shortness of breath, trouble breathing.
   5. Abdominal pain, vomit constantly, inability to eat, bloody stool, painful urination.
   6. Skin rash, swollen foot or redness and heated skin, purple spots or bleeding spots on the skin.

Principles of care for fever:

1. Provide a comfy environment: Adjusting the room temperature, improving air circulation, avoiding direct wind blowing to the patients and keeping the environment comfortable.
2. Adequate water, electrolytes and nutrition: drink more water (3000ml per day for adults) and replenish electrolytes properly, as well as having frequent light meals.
3. Hygiene and comfortable: Adding clothes and quilts in the stage of onset of fever; reducing clothes and quilts, improving air circulation, helping them take a bath or change clothes if the patient is sweating in the stage of extremely high temperature of fever.
4. Measure the body temperature every 4 hours: Be cautious of the external factors that will affect the temperature, such as exercise, wearing too much clothes and sun exposure. If the external factors are present, the temperature should be measured again after resting for half an hour.
5. Take a tepid sponge bath (warm bath): 
   1. In recent studies, a tepid sponge bath has no significant effect on decreasing the body temperature of a febrile child. And can cause discomfort including chills, or shivering.
   2. It is advised to control the water temperature at 27°C ~33°C and should spend only 10-30 minutes each time with gently stroke. Stop any time if the individual expresses any discomfort during the process.
6. Ice pillow or cooling patch, etc. can cause local vasoconstriction, which hinders heat dissipation. They are not recommended for using regularly.
7. Antipyretics: the treatments of fever should be to improve the sense of comfort, rather than to reduce body temperature.
   1. When the cause of fever is uncertain, it is recommended not to use antipyretics to reduce body temperature. Because antipyretics may cover the symptoms of the disease, making the disease hard to assess correctly. 
   2. Patients with known chronic diseases (e.g. heart and lung disease, epilepsy etc.), in order to avoid deteriorating previous physical disorder. Antipyretics can be used to alleviate the discomfort caused by fever. However, they cannot shorten the course of the disease as well as prevention for febrile seizure. 
       

1. Green, C., Krafft, H., Guyatt, G., & Martin, D. (2021). Symptomatic fever management in children: a systematic review of national and international guidelines. PloS one, 16(6), e0245815. https://doi.org/10.1371/journal.pone.0245815
2. Gu, J. C., Tai, C.Y., Jou, H.J., Lee, H. F. (2020). Improving nursing staff's cognition and treatment integrity of heat injury treatment, Tzu Chi Nursing Journal, 19(6), 77-91. https://doi.org/10.6974/TCNJ
3. National Institute for Health and Care Excellence. (2021, Nov. 21). Fever in under 5s: assessment and initial management. https://www.nice.org.uk/guidance/ng143/chapter/Recommendations
4. UpToDate. (2022, Nov. 23). Pathophysiology and treatment of fever in adults. https://www.uptodate.com/contents/pathophysiology-and-treatment-of-fever-in-adults