Post-OP Pyrexia Flashcards
Pyrexia
Typically >37.5C
Causes of pyrexia
Infection
Iatrogenic
VTE
Secondary to prosthetic implantation
PUO
Infection causes 1-2 days after
Respiratory source
Infection causes 3-5 days after
Urinary tract source
Infection causes 5-7 days after
Consider a surgical site infection or abscess/collection formation
What infection should you always consider regardless of day after?
Infected IV lines
Central lines
Iatrogenic causes of pyrexia
Drug-induced reaction like abx or anaesthetic agents or from transfusion reaction
What secondary prosthetic might cause pyrexia?
Any foreign body can cause a low-grade fever
What is PUO?
Recurrent fever >38C persisting for >3wks without an obvious cause despite >1wk of inpatient investigation
Causes of PUO
Infection of unknown source (30%)
Malignancy (classically lymphoma, 30%)
Connective tissue diseases or vasculitis (30%)
Drug reactions
Clinical features
A to E approach
Urinary frequency, dysuria, productive cough, dyspnoea, haemoptysis, chest or calf pain
Wound or IV line tenderness
Discharge
Investigations
Septic screen of….
Bloods - FBC, CRP and U&Es
Urine dipstick
Cultures like blood, urine, sputum and wound swab
Imaging - CXR
CT scan (anastomotic leak), Doppler US (DVT)
If no infectious source can be identified, should empirical abx be started?
No
Look for non-infectious causes first and consulta senior colleague and a microbiologist.
Conservative management
Hydration
Anti-pyrexials and analgesia
Empirical abx of…
LRTI
Lower UT
Upper UT
Surgical site/Cellulitis
IV line
Intra-abdominal
SA
Unknown source
LRTI - Co amoxiclav PO TDS for 5 days
Lower UT - Trimethoprim 200mg POD BD for 3 days
Upper UT - Co-amoxiclav 625mg PO TDS for 14 days
Surgical site/Cellulitis - Fluclox 500mg PO QDS for 5 days
IV line - Fluclox 500mg PO QDS for 5 days
Intra-abdominal - Cefuroxime 1.5g IV TDS + Metronidazole 500mg TDS IV
SA - Fluclox 2g IV QDS
Unknown source - Cefuroxime 1.5g IV TDS + Metronidazole 500mg TDS IV + Gentamicin 5mg/kg STAT
