What are the causes of an immediate (24-48 hours) post op fever?
Trauma and damage to tissue
Rare, more serious
- Malignant hyperthermia
- Uncommon causes of surgical site infection: Clostridial myonecrosis
What constitutes an adequate wound swab?
Swab deep in the wound
or if possible swab fluid that can be exuded out
What are the big 5 causes of post op fever?
IV site infection
What is septic shock (cf to severe sepsis)
Severe sepsis +
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)
What does a spiking pattern of fever commonly reflect?
What do you look for when examining a surgical wound?
Palpate for tenderness, flutuance, crepitus
What are causes of infection in the sub-acute period (after the first week)?
Drug reactions (antibiotics, phenytoin)
Other nosocomial infections
What do you do on Ex of post op fever?
IV site/spinal site
What are criteria of sepsis?
Clinical evidence of infections - eg chest, IV site, wound
Plus 2 or more of:
T>38 or <36
WBC >14,000 or >10% band forms
What is the Abx of choice for Staph wound infection?
Cefazolin if allergic to penicilin and MSSA
Vancomycin if MSRA
What symptoms can reflect septicaemia?
What are the most common causes of nosocomial pneumonia?
Anaerobic, gram negative bacili - E. coli, Klebsiella, Enterobacter, Pseudomonas
What is malignant hyperthermia?
Uncontrolled muscle contraction in response to aesthetics
What is severe sepsis cf sepsis?
Organ dysfunction - eg AKI or confusion
Impaired tissue perfusion - reflected by increased serum lactate
What are the antibiotics of choice for nosocomial pneumonia?
Ceftriaxone on the wards
Tazocin for more at risk
What do you ask on Hx for post op fever?
Localising symptoms of infections
- Cough, SOB, pleuritic pain
- Surgical site pain
- Painful IV site
- Urinary symptoms
- Pain in calves
What are causes of infection in the delayed period (after 1 month)?
Viruses and transfusion (CMV)
What class of Abx is vancomycin?
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
What is the difficulty with central lines and post op fever?
They don't show any signs of infection