Postoperative fever

Question 1

what are the big 5 causes of postoperative fever?

Answer 1

Surgical sites, IV sites, UTIs (due to urinary catheter), hospital acquired/aspiration pneumonia, DVT

Question 2

what are common causes of immediate post op fever?

Answer 2

trauma/damage to tissues, including haematoma

Question 3

what are some rare serious causes of immediate post op fever?

Answer 3

malignant hyperthermia and surgical site infections such as clostridial myonecrosis

Question 4

what are some subacute causes of post op fever (other than surgical site/ IV site infections

Answer 4

DVT, drug reactions and other nosocomial infections such as clostridium difficile

Question 5

which drugs cause fever?

Answer 5

antibiotics (beta lactam) phenytoin etc.

Question 6

what do you think for a delayed fever post operatively, where ‘delayed’ is after 1 month post op?

Answer 6

viruses and transfusion (CMV) or again surgical site

Question 7

what do you think if you see a patient post op with swinging fevers?

Answer 7

abscess

Question 8

what should you ask in anyone who has had postoperative fever?

Answer 8

presence of rigors and severe myalgia. Most likely due to a bacterial infection

Question 9

what do we need to do when we examine the surgical site?

Answer 9

Inspect the wound- take off the dressing, look for erythema, haematoma, discharge; and Palpate. Look for tenderness fluctuance and crepitus

Question 10

what should we consider if the patient has a central line?

Answer 10

central line associated bloodstream infections usually have no inflammation at insertion site

Question 11

what is the classification of sepsis?

Answer 11

Sepsis=
Clinical evidence of infection- chest IV site, wound etc

Plus 2 or more of:
Temperature > 38.5 or 1000
Respiratory rate > 25
WCC > 14000

Question 12

what should you do in a patient who you suspect has septic shock?

Answer 12

1. Escalate of care, senior review or MET call
2. Resuscitation IV fluids O2
3. Blood cultures- 2 sets of blood cultures from different sites
4. Empirical antibiotics within 60 mins

Question 13

how do we define septic shock?

Answer 13

Septic shock= severe sepsis plus

Systolic BP

Question 14

what is severe sepsis?

Answer 14

Severe sepsis = sepsis plus
Organ dysfunction (acute kidney injury, confusion)
Impaired tissue perfusion (increased serum lactate level)