BASIC MEDICAL CARE - Medicine for Mountaineering and Other Wilderness Activities - page 16

thermometer is preferable. It should be lubricated, gently inserted about 1.5 inches into the
rectum, and left for three minutes.
Any person who is delirious or thrashing about must be watched carefully and perhaps
restrained to prevent breaking the thermometer regardless of where the temperature is
measured. Taking the temperature may have to be postponed until the person is calmer.
As long as an illness persists, the temperature and pulse rate should be recorded every
four hours. Fevers sometimes follow specific patterns that are diagnostically helpful. The
temperature may go up and stay up, gradually coming down at the termination of the ill-
ness, or it may spike to high levels and then fall to normal or below normal every day
or every second or third day. A record is essential for such patterns to be recognized.
(A soundly sleeping individual rarely needs to be awakened just to have the temperature
taken.)
A moderate fever, although it may make the person uncomfortable, does not produce
lasting harmful effects. In contrast, temperatures above 106°F (41°C), which in adults usu-
allyoccuronlywithheatstroke,cancauseirreversibledamagetoanumberoforgansifnot
promptly lowered. Covering the individual's body and extremities with wet cloths (or wet-
tingtheclothesbeingworn)andfanningtheindividualtoincreaseevaporationandcooling
is the technique used in many emergency rooms.
Cooling should be continued until the temperature is below 103°F (39.5°C) ( Chapter
27: Heat and Solar Injuries ) . If the fever is not the result of heat stroke, antipyretic drugs
may be given orally to fully conscious individuals or rectally to stuporous or comatose in-
dividuals. Ibuprofen (Advil®), acetaminophen (Tylenol®), and aspirin are all effective for
reducing fever. Because high fevers frequently recur quite rapidly, the temperature must be
watched very carefully until the individual is clearly recovering.
Althoughtheindividual'stemperaturemayneedtobelowered,protectionfromenviron-
mental extremes of heat or cold must be provided, including redressing in clothing similar
to that being worn by everyone else. The individual should not be closed up in a sleeping
bag that traps the heat and can cause the temperature to go up again, unless sleeping bags
are necessary for everyone else to keep warm.
Chills
An individual with a chill shivers uncontrollably and feels cold and miserable. These
symptoms are produced by the entry of showers of microorganisms into the bloodstream.
In comparison with the usual chills resulting from exposure to cold, chills caused by infec-
tion are much more severe and produce violent, uncontrollable shaking of the entire body.
Teeth chatter, the lips and nails turn purple, and the skin becomes pale and cold. (In years
past, when many hospital beds rattled distinctly, a chill could be diagnosed when the oc-
cupant was shaking hard enough to make a bed rattle.) The cold feeling persists despite