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
What empirical antibiotic should be used for an upper urinary tract source?
Co-amox for 14 days
What empirical antibiotic should be used for a surgical site/cellulitis source?
Fluclox for 5 days
What empirical antibiotic should be used for a IV line source?
Vancomycin? idk its not clear on tms lmao
What empirical antibiotic should be used for a intra-abdominal source?
Cefuroxime and metronidazole
What empirical antibiotic should be used for a septic arthritis source?
Fluclox
What empirical antibiotic should be used for an unknown source?
Cefuroxime and metronidazole and gentamicin
Should antibiotics be started if no infectious cause can be identified for post-op pyrexia?
No
What additional support can be given in patients with post-op pyrexia?
- Anti-pyrexials
- Analgesia
- Fluid balance
