STUDY - Technical - New Dacian's Medicine
Chills
(Classical / Allopathic Medicine)
Chills (rigors)
are extreme, involuntary muscle contractions with
characteristic paroxysms of violent shivering and teeth
chattering. Commonly accompanied by fever, chills tend to
arise suddenly, usually heralding the onset of infection.
Certain diseases, such as pneumococcal pneumonia, produce only
a single, shaking chill. Other diseases, such as malaria,
produce intermittent chills with recurring high fever. Still
others produce continuous chills for up to 1 hour,
precipitating a high fever.
Chills can also
result from lymphomas, transfusion reactions, and certain
drugs. Chills without fever occur as a normal response to
exposure to cold. (See Rare causes of chills.)
HISTORY:
Ask the patient when the chills began and whether they're continuous or intermittent.
Ask the patient about associated signs and symptoms, such as headache, dysuria, diarrhea, confusion, chest pain, abdominal pain, cough, sore throat, or nausea.
Ask the patient if he has allergies, an infection, or a recent history of an infectious disorder.
Ask the patient about medications he's taking and if any drug has improved or worsened his symptoms.
Ask the patient if he has received treatment (such as chemotherapy) that may predispose him to an infection.
Ask the patient about recent exposure to farm animals, guinea pigs, hamsters, dogs, and birds as well as recent insect or animal bites, travel to foreign countries, and contact with a person who has an active infection.
Ask the patient when the chills began and whether they're continuous or intermittent.
Ask the patient about associated signs and symptoms, such as headache, dysuria, diarrhea, confusion, chest pain, abdominal pain, cough, sore throat, or nausea.
Ask the patient if he has allergies, an infection, or a recent history of an infectious disorder.
Ask the patient about medications he's taking and if any drug has improved or worsened his symptoms.
Ask the patient if he has received treatment (such as chemotherapy) that may predispose him to an infection.
Ask the patient about recent exposure to farm animals, guinea pigs, hamsters, dogs, and birds as well as recent insect or animal bites, travel to foreign countries, and contact with a person who has an active infection.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs. Note temperature elevation, if present.
Inspect the skin for any evidence of insect bites, rash, or petechiae.
Palpate the lymph nodes, noting any enlargement. Inspect the throat for redness or discharge.
Auscultate the lungs for abnormal sounds.
Take the patient's vital signs. Note temperature elevation, if present.
Inspect the skin for any evidence of insect bites, rash, or petechiae.
Palpate the lymph nodes, noting any enlargement. Inspect the throat for redness or discharge.
Auscultate the lungs for abnormal sounds.
Rare causes of
chills
Chills can result from various disorders, but can be quite common around the world. So, remember to ask about recent foreign travel when you obtain a patient's history. Here are some rare disorders that produce chills:
brucellosis (undulant fever)
dengue (breakbone fever)
epidemic typhus (louse-borne typhus)
leptospirosis
lymphocytic choriomeningitis
plague
pulmonary tularemia
rat bite fever
relapsing fever.
Chills can result from various disorders, but can be quite common around the world. So, remember to ask about recent foreign travel when you obtain a patient's history. Here are some rare disorders that produce chills:
brucellosis (undulant fever)
dengue (breakbone fever)
epidemic typhus (louse-borne typhus)
leptospirosis
lymphocytic choriomeningitis
plague
pulmonary tularemia
rat bite fever
relapsing fever.
SPECIAL
CONSIDERATIONS:
Because chills are an involuntary response to an increasing body temperature set by the hypothalmic thermostat, blankets won't stop a patient's chills or shivering. Despite this, keep the room temperature as even as possible. Provide adequate hydration and nutrients, and give an antipyretic to help control fever. Irregular use of antipyretics can trigger compensatory chills.
Because chills are an involuntary response to an increasing body temperature set by the hypothalmic thermostat, blankets won't stop a patient's chills or shivering. Despite this, keep the room temperature as even as possible. Provide adequate hydration and nutrients, and give an antipyretic to help control fever. Irregular use of antipyretics can trigger compensatory chills.
PEDIATRIC
POINTERS:
Infants don't get chills because they have poorly developed shivering mechanisms.
Most classic febrile childhood infections, such as measles and mumps, typically don't produce chills.
Older children and teenagers may have chills with mycoplasma pneumonia or acute osteomyelitis.
Infants don't get chills because they have poorly developed shivering mechanisms.
Most classic febrile childhood infections, such as measles and mumps, typically don't produce chills.
Older children and teenagers may have chills with mycoplasma pneumonia or acute osteomyelitis.
AGING ISSUES:
Chills in an elderly patient usually indicate an underlying infection, such as a urinary tract infection, pneumonia (commonly associated with aspiration of gastric contents), diverticulitis, and skin breakdown in pressure areas.
Consider an ischemic bowel in an elderly patient whose reason for seeking care is fever, chills, and abdominal pain.
Chills in an elderly patient usually indicate an underlying infection, such as a urinary tract infection, pneumonia (commonly associated with aspiration of gastric contents), diverticulitis, and skin breakdown in pressure areas.
Consider an ischemic bowel in an elderly patient whose reason for seeking care is fever, chills, and abdominal pain.
PATIENT
COUNSELING:
Advise the patient to measure his temperature with a thermometer when he experiences chills and to document the exact readings and times. This will help reveal patterns that may point to a specific diagnosis.
Advise the patient to measure his temperature with a thermometer when he experiences chills and to document the exact readings and times. This will help reveal patterns that may point to a specific diagnosis.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)