For a patient with fever and rigors, is it recommended to provide a blanket?

Management of Fever and Rigors in Patients

Patients with fever and rigors should be provided with blankets for comfort while implementing appropriate temperature management strategies.1, 2

Understanding Fever and Rigors

Fever is a physiological response that serves as a defense mechanism against infection. Rigors are episodes of severe shivering accompanied by a sensation of cold that often precede or accompany fever. They are commonly associated with bacterial infections, with studies showing that 66% of patients with rigors have bacterial infections compared to 50% without rigors 3.

Temperature Management Approach

Assessment

1. Measure temperature accurately using the most reliable method available:

   • Most accurate: Intravascular, esophageal, or bladder thermistor
   • Next most accurate: Rectal, oral, and tympanic membrane measurements
   • Avoid: Axillary measurements, temporal artery estimates 1

2. Classify severity based on temperature and symptoms:

   • Cold stress: 35-37°C - Alert, possibly shivering
   • Mild hypothermia: 32-35°C - Altered mental status, shivering
   • Moderate hypothermia: 28-32°C - Decreased responsiveness, ±shivering
   • Severe/profound hypothermia: <28°C - Unresponsive, appears lifeless 1, 2

Management Protocol

For Patients with Fever and Rigors:

1. Provide blankets for comfort - This helps manage the subjective feeling of cold during rigors while implementing other fever management strategies 1, 2
2. Administer antipyretics (acetaminophen/NSAIDs) as first-line treatment
3. Consider additional cooling measures for temperatures >39°C or if clinically indicated:
   • If external cooling is needed, use warmer blanket temperatures (closer to 23.9°C rather than colder temperatures) as they:
     • Provide similar cooling rates
     • Are more comfortable for patients
     • Result in less afterfall (excessive temperature drop) 4
     • Cause less shivering 4, 5

For Patients with Hypothermia:

1. Protect from further heat loss:

   • Move to warm environment
   • Remove wet/saturated clothing
   • Cover with dry blankets
   • Insulate from ground
   • Cover head and neck 1, 2

2. Apply appropriate rewarming strategy based on severity:

   • Mild: Passive rewarming with blankets is often sufficient
   • Moderate to severe: Add active rewarming methods while continuing passive measures 1, 2

Special Considerations

Managing Rigors

• Rigors should be treated promptly as they can lead to:
  • Respiratory deterioration
  • Increased oxygen consumption
  • Patient discomfort 1
• Management includes:
  • Prophylactic acetaminophen and NSAIDs
  • Parenteral opioids if needed (meperidine or hydromorphone) 1
  • Blankets for comfort

Cautions with External Cooling

• Avoid cooling blankets set at very cold temperatures as they:
  • Are not more effective than warmer temperatures
  • Cause more temperature fluctuations
  • Increase risk of rebound hypothermia 6
  • Cause more patient discomfort 4

Monitoring

• For febrile patients:
  • Monitor vital signs
  • Assess for signs of infection
  • Evaluate for shivering
• For hypothermic patients:
  • Monitor core temperature
  • Assess level of consciousness
  • Watch for signs of cardiac dysrhythmias 2

Conclusion

Providing blankets to patients with fever and rigors is appropriate and beneficial for comfort while implementing proper temperature management strategies. The subjective feeling of cold during rigors should be addressed with blankets, while simultaneously treating the underlying cause of fever and using appropriate antipyretic medications.