Post Op Fever Flashcards Preview

Hugh's MD2 Gen Med > Post Op Fever > Flashcards

Flashcards in Post Op Fever Deck (21):
1

What are the causes of an immediate (24-48 hours) post op fever?

Usually benign

Trauma and damage to tissue

Transfusion/Medication reaction

 

Rare, more serious

- Malignant hyperthermia

- Uncommon causes of surgical site infection: Clostridial myonecrosis

1

What constitutes an adequate wound swab?

Swab deep in the wound 

or if possible swab fluid that can be exuded out

3

What are the big 5 causes of post op fever?

Pneumonia

IV site infection

Wound infection

DVT

UTI

4

What is septic shock (cf to severe sepsis)

Severe sepsis + 

Hypotension

5

What are causes of infection in the acute period (first week)?

Hospital-acquired pneumonia/aspiration pneumonia

IV site infection with bacteraemia

Surgical site infection

Urinary tract infection (only if they've had a catheter recently)

5

What does a spiking pattern of fever commonly reflect?

An abscess

5

What do you look for when examining a surgical wound?

Erythema

Haematoma

Wound breakdown

Discharge

Palpate for tenderness, flutuance, crepitus

6

What are causes of infection in the sub-acute period (after the first week)?

Surgical sites

IV sites

DVT

Drug reactions (antibiotics, phenytoin)

Other nosocomial infections

6

What do you do on Ex of post op fever?

Vitals

Surgical wound

Lungs

IV site/spinal site

Legs

Skin (rash)

7

What are criteria of sepsis?

Clinical evidence of infections - eg chest, IV site, wound

Plus 2 or more of: 

T>38 or <36

HR >90

RR >20

WBC >14,000 or >10% band forms

8

What is the Abx of choice for Staph wound infection?

Flucloxacilin

Cefazolin if allergic to penicilin and MSSA 

Vancomycin if MSRA

10

What symptoms can reflect septicaemia?

Rigors

Myalgia

11

What are the most common causes of nosocomial pneumonia?

Anaerobic, gram negative bacili - E. coli, Klebsiella, Enterobacter, Pseudomonas

Then MRSA

13

What is malignant hyperthermia?

Uncontrolled muscle contraction in response to aesthetics

14

What is severe sepsis cf sepsis?

Sepsis +

Organ dysfunction - eg AKI or confusion

Impaired tissue perfusion - reflected by increased serum lactate

15

What are the antibiotics of choice for nosocomial pneumonia?

Ceftriaxone on the wards

Tazocin for more at risk

16

What do you ask on Hx for post op fever?

Pain

Localising symptoms of infections

- Cough, SOB, pleuritic pain

- Surgical site pain

- Painful IV site

- Urinary symptoms

- Pain in calves

18

What are causes of infection in the delayed period (after 1 month)?

Surgical site

Viruses and transfusion (CMV)

19

What class of Abx is vancomycin?

Glycopeptide

20

What do you do in case of sepsis?

Escalation of care - senior review or MET call

Resuscitation - IV fluids, O2

Investigation - blood cultures, lactate, clotting

Empirical antibiotics with 60 minutes

21

What is the difficulty with central lines and post op fever?

They don't show any signs of infection