Ch. 28 Fever

Question 1

Define post-op fever.

Answer 1

Temperature >38.5 C or 101.5 F

Question 2

What are the classic W’s of post-op fever (5) and timing?

Answer 2

• Wind - atelectasis
  
  • First 24-48 hrs
• Water - UTI
  
  • Anytime after POD3
• Wound - wound infection
  
  • Anytime but usually after POD5
• Walking - DVT/thrombophlebitis
  
  • POD7 to POD10
• Wonder drugs - drug fever
  
  • Anytime

Question 3

What is the most common cause of fever on post-op days 1 and 2?

Answer 3

Atelectasis

Question 4

What is a “complete” fever workup?

Answer 4

• Physical exam (look at wound, etc…)
• CXR
• Urinalysis
• Blood cultures
• CBC

Question 5

What causes fever before 24 post-op hours?

Answer 5

• Atelectasis
• B-hemolytic streptococcal or clostridial wound infections
• Anastomotic leak

Question 6

What causes fever from POD3 to POD5?

Answer 6

• UTI
• Pneumonia
• IV site infection
• Wound infection

Question 7

What is an anesthetic cause of fever INTRAoperatively?

Answer 7

Malignant hyperthermia–treat with DANTROLENE

Question 8

What causes wound infection on POD1 to POD2?

Answer 8

• Streptococcus
• Clostridia (painful bronze-brown weeping wound)

Question 9

What can cause fever at any time?

Answer 9

1. IV site infection
2. Central line infection
3. Meds

Question 10

What causes fever from POD5 to POD10?

Answer 10

• DVT
• Peritoneal abscess
• Drug fever