ID Miscellany|physical Exam|Signs|Humanities #idmesh
๐๐๐ข๐ฅ๐๐ง๐๐ฉ๐ช๐ง๐-๐ฅ๐ช๐ก๐จ๐ ๐๐๐จ๐จ๐ค๐๐๐๐ฉ๐๐ค๐ฃ (๐๐๐๐๐ฉ'๐จ ๐จ๐๐๐ฃ)
1/11
For every 1 deg F rise in temp, HR incrementally increases by 8-10 bpm (๐๐ฒ๐ฎ๐ซ๐ฎ๐ป๐ถ๐ฎ๐ฒ๐ผ๐ฝ๐ฎ๐ปโ๐ผ ๐ป๐พ๐ต๐ฎ)
academic.oup.com/qjmed/article/โฆ
๐๐๐ข๐ฅ๐๐ง๐๐ฉ๐ช๐ง๐-๐ฅ๐ช๐ก๐จ๐ ๐๐๐จ๐จ๐ค๐๐๐๐ฉ๐๐ค๐ฃ (๐๐๐๐๐ฉ'๐จ ๐จ๐๐๐ฃ)
1/11
For every 1 deg F rise in temp, HR incrementally increases by 8-10 bpm (๐๐ฒ๐ฎ๐ซ๐ฎ๐ป๐ถ๐ฎ๐ฒ๐ผ๐ฝ๐ฎ๐ปโ๐ผ ๐ป๐พ๐ต๐ฎ)
academic.oup.com/qjmed/article/โฆ
2/11
This is a physical sign that may have become less popular now because of more sophisticated methods of diagnosing infections.
But knowing its application can expand our clinical reasoning toolkit and enhance bedside diagnosis and teaching.
This is a physical sign that may have become less popular now because of more sophisticated methods of diagnosing infections.
But knowing its application can expand our clinical reasoning toolkit and enhance bedside diagnosis and teaching.
3/11
There are a couple of ways to determine whether ๐๐๐ข๐ฅ๐๐ง๐๐ฉ๐ช๐ง๐-๐ฅ๐ช๐ก๐จ๐ ๐๐๐จ๐จ๐ค๐๐๐๐ฉ๐๐ค๐ฃ is present.
โช๏ธ using a math equation to derive a cut-off HR below which, a diagnosis of "relative bradycardia" can be made
โช๏ธ applying a set of criteria
There are a couple of ways to determine whether ๐๐๐ข๐ฅ๐๐ง๐๐ฉ๐ช๐ง๐-๐ฅ๐ช๐ก๐จ๐ ๐๐๐จ๐จ๐ค๐๐๐๐ฉ๐๐ค๐ฃ is present.
โช๏ธ using a math equation to derive a cut-off HR below which, a diagnosis of "relative bradycardia" can be made
โช๏ธ applying a set of criteria
4/11
Ostergaard, et al proposed a calculation to determine โrelativeโ bradycardia" -- a pulse rate lower than 95% CI for the patientโs temp (determined among 673 patients ๐):
Men: if HR <10.2 x T0C โ 333
Women: if HR <11 x T0C โ 359
sciencedirect.com/science/articlโฆ
Ostergaard, et al proposed a calculation to determine โrelativeโ bradycardia" -- a pulse rate lower than 95% CI for the patientโs temp (determined among 673 patients ๐):
Men: if HR <10.2 x T0C โ 333
Women: if HR <11 x T0C โ 359
sciencedirect.com/science/articlโฆ
5/11
On the other hand, Cunha proposed a more permissive criteria to determine relative bradycardia ๐, based on:
โช๏ธ a set of inclusion/exclusion criteria
โช๏ธ set of expected HRs per given temp
sciencedirect.com/science/articlโฆ
On the other hand, Cunha proposed a more permissive criteria to determine relative bradycardia ๐, based on:
โช๏ธ a set of inclusion/exclusion criteria
โช๏ธ set of expected HRs per given temp
sciencedirect.com/science/articlโฆ
6/11
Whatever method you use, once you determine that โrelative bradycardiaโ is present, you can look at a list and be familiar with the many conditions (infectious and non-infectious) that it has been traditionally associated with ๐
sciencedirect.com/science/articlโฆ
Whatever method you use, once you determine that โrelative bradycardiaโ is present, you can look at a list and be familiar with the many conditions (infectious and non-infectious) that it has been traditionally associated with ๐
sciencedirect.com/science/articlโฆ
7/11
The exact sensitivity and specificity of the Fagetโs sign is unknown. But data seems to show its diagnostic value in the following infections:
1โฃ Legionella
2โฃ Chlamydia
3โฃ Salmonella typhi (typhoid fever)
4โฃ Dengue
The exact sensitivity and specificity of the Fagetโs sign is unknown. But data seems to show its diagnostic value in the following infections:
1โฃ Legionella
2โฃ Chlamydia
3โฃ Salmonella typhi (typhoid fever)
4โฃ Dengue
8/11
Among close to 700 patients, relative bradycardia had no predictive value regarding most likely infection but found only in specific diseases:
โช๏ธ typhoid fever (but NOT non-typhi Salmonella)
โช๏ธ Legionella & Chlamydia pneumonia (but NOT Mycoplasma)
sciencedirect.com/science/articlโฆ
Among close to 700 patients, relative bradycardia had no predictive value regarding most likely infection but found only in specific diseases:
โช๏ธ typhoid fever (but NOT non-typhi Salmonella)
โช๏ธ Legionella & Chlamydia pneumonia (but NOT Mycoplasma)
sciencedirect.com/science/articlโฆ
9/11
Case-control study (N=160) in Japan, the presence of relative bradycardia was diagnostic of typhoid fever (OR 11.7, LR+ 1.72).
journals.plos.org/plosone/articlโฆ
Case-control study (N=160) in Japan, the presence of relative bradycardia was diagnostic of typhoid fever (OR 11.7, LR+ 1.72).
journals.plos.org/plosone/articlโฆ
10/11
Case control study (N=70) in Singapore, relative bradycardia was a significant feature of dengue but not other causes of infection (p < 0.001))
wwwnc.cdc.gov/eid/article/13โฆ
Case control study (N=70) in Singapore, relative bradycardia was a significant feature of dengue but not other causes of infection (p < 0.001))
wwwnc.cdc.gov/eid/article/13โฆ
11/11
So next time you see a febrile patient (e.g. patient coming w/ CAP, returned traveler), try to see if you can apply the ๐๐๐๐๐ฉ'๐จ ๐จ๐๐๐ฃ.
Has this sign ever been useful in your practice? Tell us about it. @DocWoc71 @BradCutrellMD @CarlosdelRio7 @PaulSaxMD @TxID_Edu
So next time you see a febrile patient (e.g. patient coming w/ CAP, returned traveler), try to see if you can apply the ๐๐๐๐๐ฉ'๐จ ๐จ๐๐๐ฃ.
Has this sign ever been useful in your practice? Tell us about it. @DocWoc71 @BradCutrellMD @CarlosdelRio7 @PaulSaxMD @TxID_Edu
โข โข โข
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