Management

1. Fever-Reducing Medication

Choose ONE:  ├─ Acetaminophen (Tylenol): 650-1000mg for adults  
             └─ Ibuprofen (Advil/Motrin): 400-600mg for adults    
DO NOT combine both initially  
Set timer to recheck temperature in 30-45 minutes  

2. Begin Cooling Measures Simultaneously

• Remove excess clothing/blankets
• Move to cool room (air conditioning if available)
• Apply cool (not cold) wet cloths to forehead, neck, armpits, groin
• Use a fan to circulate air
• Do NOT use ice baths or alcohol rubs (can cause shivering, raising temperature)

3. Hydrate Aggressively

• Drink water, electrolyte drinks, or clear fluids
• Small sips frequently if nauseous
• Aim for 8-16 oz in first hour

Confusion, disorientation, or difficulty staying awake
   
├─ Severe headache with stiff neck  
├─ Difficulty breathing or chest pain  
├─ Seizure or convulsions  
├─ Severe abdominal pain  
├─ Persistent vomiting (can't keep fluids down)  
├─ Rash that doesn't blanch when pressed  
├─ No urination for 8+ hours (severe dehydration)  
├─ Immunocompromised status  
├─ Recent chemotherapy/transplant  
└─ Pregnant  

++++++++++++++++++CALL DOCTOR/SEEK URGENT CARE if:

• Temperature doesn't drop below 39°C (102.2°F) after 2 hours of treatment
• This is a second episode of 40°C+ fever
• Fever has persisted >3 days already
• You have chronic medical conditions (diabetes, heart disease, lung disease)
• Age >65 or <3 months

MONITOR AT HOME if:

• No red flag symptoms present
• Otherwise healthy adult
• Temperature responds to medication
• Can tolerate fluids
• First day of illness

MONITORING PROTOCOL (If staying home)

First 2 Hours:

Every 30 minutes:  ├─ Check temperature  ├─ Assess mental status (alert and oriented?)  ├─ Monitor for new symptoms  └─ Continue hydration    Temperature dropping?  ├─ YES → Continue to 4-hour monitoring  └─ NO or worsening → Seek medical care  

Hours 2-6:

Every 1-2 hours:  ├─ Temperature checks  ├─ Maintain hydration  ├─ Can give second dose of medication per package instructions  │  (Usually 4-6 hours after first dose)  └─ Rest in cool environment    Temperature controlled below 39°C?  ├─ YES → Continue monitoring, regular follow-up protocol  └─ NO → Contact healthcare provider  

MEDICATION SCHEDULE for 40°C

Option A: Single agent

• Acetaminophen 650-1000mg every 6 hours (max 4000mg/24hrs)
• OR Ibuprofen 400-600mg every 6-8 hours (max 2400mg/24hrs)

Option B: Alternating (if fever very resistant)

• Only under medical guidance
• Acetaminophen → 3 hours later → Ibuprofen → 3 hours later → Acetaminophen
• This provides medication every 3 hours but avoids overdose
• Carefully track doses and times

SPECIAL SITUATIONS

Child with 40°C:

Age-specific action:  ├─ Under 3 months → EMERGENCY ROOM immediately (any fever)  ├─ 3-6 months → Call pediatrician immediately  ├─ 6 months - 5 years → Higher risk for febrile seizures  │  └─ If seizure occurs → Call 911  └─ Over 5 years → Follow general protocol with pediatric dosing  

Heat-Related (Heat Stroke):

If fever due to heat exposure:  ├─ This is MEDICAL EMERGENCY  ├─ Call 911  ├─ Move to cool area immediately  ├─ Remove clothing  ├─ Apply cool water/ice packs to armpits, groin, neck  └─ Do NOT give fever medication (won't help heat stroke)  

Post-Surgery or Immunocompromised:

40°C in these contexts → CALL DOCTOR IMMEDIATELY  May indicate serious infection requiring IV antibiotics  

WHAT NOT TO DO

❌ Do NOT:

• Bundle up or "sweat it out"
• Use ice baths or rubbing alcohol
• Exceed maximum medication doses
• Ignore worsening symptoms
• Delay seeking care if red flags appear
• Give aspirin to children/teens (Reye's syndrome risk)

FOLLOW-UP

Even if temperature comes down:

• Monitor every 4-6 hours for next 24 hours
• See doctor if fever persists beyond 3 days total
• Watch for development of localizing symptoms (cough, pain, rash, etc.)
• Keep medication schedule written down to avoid accidental overdose

KEY PRINCIPLE

40°C (104°F) represents the threshold where fever itself can become dangerous, not just the underlying cause. The body's proteins can begin to denature at sustained temperatures above 41-42°C (105.8-107.6°F). While most fevers won't reach this level, aggressive treatment at 40°C is warranted to prevent further rise, and medical evaluation is necessary if it doesn't respond quickly to treatment or if any concerning symptoms develop.

When in doubt at this temperature, err on the side of seeking medical evaluation.