Post-Op Pyrexia Flashcards
What temp is pyrexia?
37.5
What can cause pyrexia post-op, broadly?
- Underlying disease process
- Post-op complication
What is the most common cause of post-op pyrexia?
Infection
What can indicate the source of post-op pyrexia caused by infection?
The specific post-op day on which the fever develops
What source should be suspected if pyrexia develops on day 1-2?
Respiratory
What source should be suspected if pyrexia develops on day 3-5?
Urinary tract
What source should be suspected if pyrexia develops on day 5-7?
Surgical site infection or abscess/collection formation
What source should be suspected if pyrexia develops any day post-op?
Infected IV lines or central lines
What should the investigation of post-op infection source be tailored to?
The patient
What are the other causes of post-op pyrexia?
- Iatrogenic
- VTE (kinda rare)
- Secondary to prosthetic implantation
- Pyrexia of unknown origin
What can cause iatrogenic post-op pyrexia
- Drug induced reaction, e.g. abx, anaesthetic agents
- Transfusion reaction
What is pyrexia of unknown origin (PUO)?
A recurrent fever persisting for 3 weeks without an obvious cause, despite >1 week of inpatient investigation
What are the causes of PUO?
- Infection of unknown source
- Malignancy
- Connective tissue diseases or vasculitis
- Drug reactions
What is the typical malignant cause of PUO?
B-symptoms from lymphoma
What determines the clinical presentation of a patient with post-op pyrexia?
Underlying source of pyrexia
What should be done if no obvious source of infection is apparent in post-op pyrexia?
Enquire about specific symptoms, such as;
- Urinary frequency
- Urgency
- Dysuria
- Productive cough
- Haemoptysis
- Chest or calf pain
- Wound or IV line tenderness or discharge
What should be done on examination in post-op pyrexia?
Examine for signs of;
- Pulmonary infection
- IV line infections
- Wound infections
- Calf tenderness
What investigations should be done in post-op pyrexia?
Septic screen, which can include;
- Blood tests
- Urine dipstick
- Cultures
- Imaging
What bloods may be included in septic screen for post-op pyrexia?
- FBC
- CRP
- U&Es
What cultures may be done in septic screen for post-op pyrexia?
- Blood
- Urine
- Sputum
- Wound swab
What may be required if a source of infection cannot be identified through the septic screen in post-op pyrexia?
More detailed investigations may be required, such as CT scan for any suspected anastomotic leak, or Doppler US for suspected DVT
How should any identified infection causing post-op pyrexia be managed?
Should be treated empirically with antibiotics, pending sensitivity results
What empirical antibiotic should be used for a lower respiratory tract infection source?
Co-amox for 5 days
What empirical antibiotic should be used for a lower urinary tract source?
Trimethoprim for 3 days
