Post Operative Complications

Question 1

Identify the five causes of post-operative fever and the likely timing of each.

Answer 1

1. Wind (respiratory tract) –> 1 to 2 days
2. Water (urinary tract) –> 3 to 5 days
3. Wound (surgical site infection) –> 5 to 7 days
4. Walk (DVT or PE) –> 8+ days
5. “What have we done?” (iatrogenic) –> any time

N.B Fever within the first 24 hours is usually a physiological response to stress.

Fever > 7 days post-op is suggestive of an abscess.

Question 2

Identify empirical antibiotics for the following causes of fever: 
✔️ lower respiratory tract infection
✔️ lower urinary tract infection
✔️ skin infection
✔️ septic arthritis 
✔️ GIT infection
✔️ unknown

Answer 2

LOWER RESPIRATORY - amoxicillin + clavulanic acid

LOWER URINARY TRACT - trimethoprim

SKIN INFECTION - flucloxacillin

SEPTIC ARTHRITIS - flucloxacillin

GIT - metronidazole

UNKNOWN - ceftriaxone + metronidazole + gentamicin

Always use VANCOMYCIN for MRSA infections.

Question 3

Define DELIRIUM. What are the most common causes of delirium?

Answer 3

Delirium is a transient and reversible change to cognitive function (including orientation, awareness, personality and memory). It is important to recognise that patients can present as either hypo or hyper active in the context of delirium.

Causes for delirium include:
✔️ D - drugs (e.g. withdrawal OR intoxication)
✔️ E - electrolyte abnormalities (e.g. hyponatremia, hypokalaemia)
✔️ L - loss of oxygen (e.g. anaemia, MI, PE)
✔️ I - infection (e.g. pneumonia, UTI)
✔️ R - retention (e.g. constipation, urinary retention)
✔️ I - intracranial pathology (e.g. SDH, EDH, stroke, infection)
✔️ U - uremia
✔️ M - metabolic (e.g. hypoglycaemia)

Other causes for delirium include:
✔️ pain
✔️ disorientation

Question 4

Outline appropriate investigations for delirium.

Answer 4

In the context of delirium, it is important to identify and treat the underlying cause.

✔️ urine dipstick + MCS +/- toxicology
✔️ ABG
✔️ blood glucose level
✔️ ECG
✔️ FBC + WCC
✔️ Inflammatory markers
✔️ UECs
✔️ eLFTs
✔️ TFTs
✔️ blood culture
✔️ Iron studies
✔️ Vitamin B12 + folate 
✔️ Syphilis serology
✔️ CXR
✔️ non-contrast CT head