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Flashcards in Post Operative Fever Deck (16):

What are the DDx for post operative fever?

The Big Five:
• Surgical site
• IV sites
• Pneumonia


Causes of IMMEDIATE post op fever

a. Usually mild fever (often benign) due to:
• Transfusion reaction, medication reaction
• Infection prior to surgery
• Trauma
b. Malignant hyperthermia (very rare)


Causes of ACUTE (first week) post op fever

– Hospital acquired pneumonia/ aspiration pneumonia
– IV site infection with bacteraemia
– Urinary tract infection
– Surgical sites


Causes of SUB ACUTE ( after first week) post op fever

– Surgical sites
– IV sites
– Drug reactions (antibiotics, phenytoin, others) – Other nosocomial infections, esp if in ICU


Causes of DELAYED (after a month) post op fever

– Surgical site
– Viruses and transfusion (CMV)


What dose a swinging fever (spiking temperature) indicate?

Accumulation of pus - abscess, empyema, subdiaphragmatic abscess, epidural abscesses


How do you distinguish the big five DDx for post op fever?

On history ask about:
• Symptoms of fever
• Pain in the of op, duration, movement, restricted, analgesic requirements
• Shortness of breath, cough, sputum production, pleuritic chest pain
• Urinary catheter-in-situ, dysuria, frequency
• Pain in the calves, peripheral IV sites


Steps of examination in post op fever

• Vital signs- eg. BP, pulse, respiratory rate (tachypnoea), O2 saturation, temperature
• Surgical wound
• IV sites/Spinal site
• Chest
• Legs
• Skin (rash)


Key factors when examining the surgical site

• Inspection- erythema, haematoma, wound breakdown, discharge
• Palpate- tenderness, fluctuance, crepitus
• +/- imaging


Key factors when examining the IV and other invasive sites

• IV, arterial line, central line, drain site- inspect all sites, note date inserted, when they were changed
• Drains sites may get infected or be an indicator of deep infection- purulent fluid
• Central line-associated bloodstream infections usually have no localising signs


Key factors when examining the urinary tract

• Was a catheter used or still in situ- is it blocked? What colour is the urine?
• (Bacteruria very common in catheterised patients, but often asymptomatic and not requiring treatment)


Key factors when examining the lungs

• Chest signs- crepitations, dullness to percussion: ? consolidation, ? effusion
• Pulmonary infection versus pulmonary embolus
• NB other non infectious causes of chest signs: ARDS, left ventricular failure/fluid overload


Key factors when examining the legs

• DVT- swelling, tender calf, or no signs but high risk
• Check thromboprophylaxis- eg. TEDS, Clexane, Pneumatic calf compressors
• Investigate- Doppler US


What are the risk factors for surgical site infection?

• Host factors: age, obesity, malnutrition, diabetes, steroids, smoking, infection at another site, skin carriage of Staph aureus
• Type of surgery, wound class, surgical technique, operation duration, hair removal, skin prep used, hypothermia
• Inadequate surgical antibiotic prophylaxis- antibiotic choice, timing
• Theatre traffic


Treatment of post op fever due to surgical site infection

- Abx
- If infection of site or joint, then complete evacuation of infected site, lavage of joint (wash out well!)


What percentage of MRSA infections of all S. aureus infections?

Rx with vancomycin