ED Pathway for the Evaluation/Treatment of the Oncology Patient with Fever

Triage/Contact Precautions/LMX

Do not do rectal temperature

1 Critical 2 Acute 3 Urgent 4 Urgent 5 Non-Urgent
 
  • Fever, hx:  fever > 38°C (100.4°F) with:

    • Age < 8 weeks
    • Oncologic disorder
    • Central line in place
    • Special immunology
    • Organ transplantation
    • Neutropenia
  • Fever, hx:  fever > 38.4°C (101.1°F) with sickle cell disease
 
  • >38°C with age 9-12 weeks
  • Females > 39°C and <12 months

  • Uncircumcised males
    > 39°C  and <12 months

  • Fever >3 days

 

LMX

Apply to line site if this has not already been done by the family.

Contact Precautions

Initiate precautions for all patients at Triage to include:

Age Group Respiratory Rate Heart Rate Systolic Blood Pressure  Diastolic Blood Pressure Weight in Kilos Consider Higher Acuity w/o Presence of Fever
Newborn 30-50 120-160 50-70 30-60 2-3 >180 HR
Infant
(1-12 mos)
20-30 80-140 70-100 53-66 4-10 >180 HR
Toddler
(1-3 yrs)
20-30 80-130 80-110 53-66 10-14 >140 HR
Preschooler
(3-5 yrs)
20-30 80-120 80-110 55-69 14-18 >140 HR
School Age
(6-12 yrs)
20-30 70-110 80-120 57-71 20-42 >130 HR
Adolescent (13+ yrs) 12-20 55-105 110-120 66-80 > 50 >110 HR

Key Points to Remember

  • Every degree Celsius rise in temperature should only show a ten percent rise in heart rate
  • If one vital sign parameter is abnormal, then a full set of vital signs should be attempted
    • Exception: unable to obtain an accurate blood pressure on a crying and kicking child
  • Reset triage blood pressure machines between each patient
  • If the heart rate is low normal or high normal, assess further