Post-op fever

Question 1

Red flags for sepsis

Answer 1

• RR 25 or more
• HR >130
• Systolic 90 or less or a drop of 40mmHg from baseline
• No urine output for 16hrs or <10ml/hr
• New delirum
• Responds to only voice, pain or is unresponsive
• Non-blanching/mottled/ashen/cyanotic
• Neutropaenia or chemo within last 6 weeks

Question 2

When to initally think about sepsis?

Answer 2

• EWS 3 or more OR
• Patient looks unwell OR
• Concern re acute mental state
• Clinical picture suggesting infection

Question 3

Two underlying causes of pyrexia post op

Answer 3

• Normal immediate post op response
• Post-op complication

Question 4

Most common cause post-op fever

Answer 4

Infection

Question 5

Specific day post op fever occurs and what cause is likely to be

Answer 5

• Day 1-2 - ‘WIND’ respiratory source (or routine response)
• Day 3-5 ‘WATER’ - respiratory or urinary
• Day 4-6 ‘WALK’ - DVT/PE
• Day 5-7 ‘WOUND’ - surgical site infection/abscess formation
• 7+ - ‘WONDER’ - about drugs?

Think specific to surgery eg if bowel anastomosis think anastomic leak

Question 6

Other causes of post-op fever other than infection

Answer 6

• Iatrogenic - drug induced eg antibiotics/anaesthetic agents or transfusion reaction
• VTE - PE or DVT
• Secondary to prosthetic implantation
• Pyrexia of unknown origin PUO

Question 7

What is PUO?

Answer 7

• Recurrent fever (>38) peristing for >3weeks without an obvious cause
• Despite >1week of inpatient investigations
• Causes inc infection of unknown source, malignancy, connective tissue disease, vasculitis, drug reactions

Question 8

Assessing a patient with post-op fever

Answer 8

• A-E assessment
• Stabilise patient and then identify source

Question 9

What questions to ask if no obvious signs apparent?

Answer 9

• Wind - productive cough, SOB
• Water - urgency, frequency, dysuria
• Walk - haemoptysis, chest/calf pain
• Wound - wound or cannula line tenderness

Question 10

Investigations for post-op fever - bedside

Answer 10

• Urine dipstick +/- MC&S
• Cultures - blood, urine, sputum, wound swab

Question 11

Bloods for post op fever

Answer 11

• FBC
• CRP
• U&E
• LFTs
• Clotting

Question 12

Imaging for post op fever

Answer 12

• CXR
• Specific cross sectional imaging eg CT if needed

Question 13

Management post-op fever

Answer 13

• Treat underlying cause
• If infection, antibiotics “according to local hospital guidelines”
• Escalate to senior if sepsis
• Remember not all causes are infective though