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Surgical sieve
🌡️ Fever
Find the source: chest, urine, abdomen, skin, lines, CNS, joints. Then think beyond infection.
| Sepsis of any source Must exclude | NEWS ≥5, tachycardia, hypotension, confusion, raised lactate.Sepsis 6 within 1 hour. |
|---|---|
| Neutropenic sepsis Must exclude | Any fever within 6 weeks of chemotherapy. May have no other signs.Antibiotics within 1 hour — do not wait for the neutrophil count. |
| Meningitis Must exclude | Headache, photophobia, neck stiffness, non-blanching rash.Antibiotics immediately; do not delay for LP or CT. |
| Malaria Must exclude | Any fever with travel to an endemic area in the last year.Thick and thin films within 1 hour; three sets to exclude. |
| Infective endocarditis Time-sensitive | Fever with a new murmur. Splinter haemorrhages, embolic phenomena.Three sets of blood cultures from different sites, echo. |
| Line or catheter infection Time-sensitive | Look at every line site. Fever with no other source in an inpatient.Inspect and consider removing the line; peripheral + line cultures. |
| Pneumonia Time-sensitive | Cough, focal chest signs, hypoxia. |
| Urinary tract infection / pyelonephritis Time-sensitive | Dysuria, loin pain, vomiting. |
| Intra-abdominal collection Time-sensitive | Post-operative swinging fever. Often days 5–7 post-op.CT abdomen; may need drainage. |
| Cellulitis / necrotising fasciitis Time-sensitive | Nec fasc: pain out of proportion, rapidly spreading, systemic toxicity, crepitus.Mark the margin. Nec fasc is a surgical emergency. |
| Venous thromboembolism Time-sensitive | PE and DVT can both cause a low-grade fever. |
| Drug fever / transfusion reaction Time-sensitive | Temporal relationship to a new drug or blood product.Stop the transfusion; review recent drug changes. |
| Malignancy Consider | Lymphoma, renal cell carcinoma. Night sweats, weight loss. |
| Inflammatory / autoimmune Consider | Vasculitis, connective tissue disease, adult Still's disease. |
14 differentials · 11 open a full pathway in the app.