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Peri-Operative Care [16] > Post-Op Pyrexia > Flashcards

Post-Op Pyrexia Flashcards

1
Q

What temp is pyrexia?

A

37.5

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2
Q

What can cause pyrexia post-op, broadly?

A
  • Underlying disease process

- Post-op complication

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3
Q

What is the most common cause of post-op pyrexia?

A

Infection

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4
Q

What can indicate the source of post-op pyrexia caused by infection?

A

The specific post-op day on which the fever develops

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5
Q

What source should be suspected if pyrexia develops on day 1-2?

A

Respiratory

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6
Q

What source should be suspected if pyrexia develops on day 3-5?

A

Urinary tract

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7
Q

What source should be suspected if pyrexia develops on day 5-7?

A

Surgical site infection or abscess/collection formation

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8
Q

What source should be suspected if pyrexia develops any day post-op?

A

Infected IV lines or central lines

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9
Q

What should the investigation of post-op infection source be tailored to?

A

The patient

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10
Q

What are the other causes of post-op pyrexia?

A
  • Iatrogenic
  • VTE (kinda rare)
  • Secondary to prosthetic implantation
  • Pyrexia of unknown origin
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11
Q

What can cause iatrogenic post-op pyrexia

A
  • Drug induced reaction, e.g. abx, anaesthetic agents

- Transfusion reaction

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12
Q

What is pyrexia of unknown origin (PUO)?

A

A recurrent fever persisting for 3 weeks without an obvious cause, despite >1 week of inpatient investigation

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13
Q

What are the causes of PUO?

A
  • Infection of unknown source
  • Malignancy
  • Connective tissue diseases or vasculitis
  • Drug reactions
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14
Q

What is the typical malignant cause of PUO?

A

B-symptoms from lymphoma

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15
Q

What determines the clinical presentation of a patient with post-op pyrexia?

A

Underlying source of pyrexia

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16
Q

What should be done if no obvious source of infection is apparent in post-op pyrexia?

A

Enquire about specific symptoms, such as;

  • Urinary frequency
  • Urgency
  • Dysuria
  • Productive cough
  • Haemoptysis
  • Chest or calf pain
  • Wound or IV line tenderness or discharge
17
Q

What should be done on examination in post-op pyrexia?

A

Examine for signs of;

  • Pulmonary infection
  • IV line infections
  • Wound infections
  • Calf tenderness
18
Q

What investigations should be done in post-op pyrexia?

A

Septic screen, which can include;

  • Blood tests
  • Urine dipstick
  • Cultures
  • Imaging
19
Q

What bloods may be included in septic screen for post-op pyrexia?

A
  • FBC
  • CRP
  • U&Es
20
Q

What cultures may be done in septic screen for post-op pyrexia?

A
  • Blood
  • Urine
  • Sputum
  • Wound swab
21
Q

What may be required if a source of infection cannot be identified through the septic screen in post-op pyrexia?

A

More detailed investigations may be required, such as CT scan for any suspected anastomotic leak, or Doppler US for suspected DVT

22
Q

How should any identified infection causing post-op pyrexia be managed?

A

Should be treated empirically with antibiotics, pending sensitivity results

23
Q

What empirical antibiotic should be used for a lower respiratory tract infection source?

A

Co-amox for 5 days

24
Q

What empirical antibiotic should be used for a lower urinary tract source?

A

Trimethoprim for 3 days

25
Q

What empirical antibiotic should be used for an upper urinary tract source?

A

Co-amox for 14 days

26
Q

What empirical antibiotic should be used for a surgical site/cellulitis source?

A

Fluclox for 5 days

27
Q

What empirical antibiotic should be used for a IV line source?

A

Vancomycin? idk its not clear on tms lmao

28
Q

What empirical antibiotic should be used for a intra-abdominal source?

A

Cefuroxime and metronidazole

29
Q

What empirical antibiotic should be used for a septic arthritis source?

A

Fluclox

30
Q

What empirical antibiotic should be used for an unknown source?

A

Cefuroxime and metronidazole and gentamicin

31
Q

Should antibiotics be started if no infectious cause can be identified for post-op pyrexia?

A

No

32
Q

What additional support can be given in patients with post-op pyrexia?

A
  • Anti-pyrexials
  • Analgesia
  • Fluid balance

Peri-Operative Care [16] (20 decks)

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