Chapter 27: Fever Flashcards
Define postoperative fever
Temperature >38.5°C or 101.5°F
What are the five classic W’s of postoperative fever?
- Wind—atelectasis
- Water—urinary tract infection (UTI)
- Wound—wound infection
- Walking—DVT/thrombophlebitis
- Wonder drugs—drug fever
Give the classic postoperative timing for the following causes of postoperative fever:
Atelectasis (Wind)
First 24 to 48 hours
Give the classic postoperative timing for the following causes of postoperative fever:
UTI (Water)
Anytime after POD #3
Give the classic postoperative timing for the following causes of postoperative fever:
Wound infection (Wound)
Usually after POD #5 (but it can be anytime!)
Give the classic postoperative timing for the following causes of postoperative fever:
DVT/PE/thrombophlebitis (Walking)
PODs #7 to #10
Give the classic postoperative timing for the following causes of postoperative fever:
Drug fever (Wonder drugs)
Anytime
What is the most common cause of fever on PODs #1 to #2?
Atelectasis (most likely cytokine release from tissue damage!)
What is a “fever” workup?
- Physical exam (look at wound)
- CXR
- urinalysis
- blood cultures
- CBC
What causes fever before 24 postoperative hours?
- Atelectasis
- cytokine release
- β-hemolytic streptococcal or clostridial wound infections
- anastomotic leak
What causes fever from PODs #3 to #5?
- UTI
- pneumonia
- IV site infection
- wound infection
What is an anesthetic cause of fever INTRAoperatively?
Malignant hyperthermia—treat with dantrolene
What causes fever from PODs #5 to #10?
- Wound infection
- pneumonia
- abscess
- infected hematoma
- Clostridium difficile colitis
- anastomotic leak
- DVT
- peritoneal abscess
- drug fever
- PE
- abscess
- parotitis
What causes wound infection on PODs #1 to #2?
- Streptococcus
- Clostridia (painful bronze-brown weeping wound)
What can cause fever at any time?
- IV site infection
- Central line infection
- Medications