Australasian Emergency Nursing Journal (2015) 18, 173

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LETTER TO THE EDITOR

Fever is not a contraindication for
a blanket
To the Editor,
I am grateful to have had the opportunity to work along-
side so many dedicated nurses who strive to provide a high
level of care for our patients. It is admirable that nurses are
so attentive not just to patients’ clinical needs but also their
comfort. This is why I was surprised recently to be chastised
for giving a blanket to a patient in the emergency depart-
ment who complained of feeling cold. The patient’s nurse
informed me that the patient had a fever and was there-
fore not permitted to have a blanket. Subsequent inquiries
suggest that this view is not unique.
The attempt to ensure that the patient did not receive
what was perceived as a harmful intervention is commend-
able, but the concerns about harm from a blanket in a
patient with a physiological fever are misguided. When dis-
cussing physiological fevers, it is important to be clear that
this means a fever, most often caused by infection, where
the fever itself is not pathological but rather is part of
the physiological response. During this response, cytokines
trigger an increase in the thermoregulatory set point (also
known as the hypothalamic set point) in the brain while also
acting peripherally to activate other pathways that increase
temperature.1
This type of physiological fever will be the case in
the majority of patients with elevated temperature in the
emergency department. It may seem counter-intuitive to
recognise the physiological nature of most fevers given
how quick we often are to treat patients with fever with
antipyretic medications. What we must recall is that the
clinical improvement seen from these medications is not due
to the reduction in fever itself but rather the antiinflamma-
tory action of these medications.2
We can be further reassured of the physiological nature of
fever by considering a large retrospective study of critically
ill patients with infectious fevers that found decreased mor-
tality in patients who had an elevated peak temperature in
the first 24 h in the intensive care unit (ICU).3 This raises the
possibility that fever is protective even in these critically ill
patients.
It is reasonable to conclude that in patients with fever
in the emergency department, it is unlikely that a blanket
will cause harm and it is likely that it will provide benefit by
increasing comfort in a patient who feels cold. Providing a
blanket will not create a negative alteration of the under-
lying physiological elevation of the thermoregulatory set
point. Denying patients a blanket in the emergency depart-
ment on the basis of a physiological fever should not be an
accepted practice.
Provenance and conflict of interest
The author has no conflicts of interest. This paper was not
commissioned
References
1. Mackowiak PA. Concepts of fever. Arch Intern Med
1998;158(17):1870—81.
2. Blatteis CM. Fever: pathological or physiological, injurious or
beneficial? J Therm Biol 2003;28(1):1—13.
3. Young PJ, Saxena M, Beasley R, Bellomo R, Bailey M, Pilcher
D, et al. Early peak temperature and mortality in critically
ill patients with or without infection. Intensive Care Med
2012;38(3):437—44.
Christopher R. Foerster, MSc
Paramedic, Final Year Medical Student, Mackay,
Queensland, Australia
E-mail address:christopher.foerster@gmail.com
7 May 2015
4 June 2015
4 June 2015

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