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Surgery > Post operative fever > Flashcards

Post operative fever Flashcards

1
Q

Q: What is the definition of postoperative fever?

A

A: Postoperative fever is defined as a systemic body temperature at or above 38 degrees Celsius or 100.4 degrees Fahrenheit within the postoperative period.

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2
Q

Q: What are the common causes of postoperative fever?

A

A: Drug or transfusion reaction, infection, and derangements of the normal healing process.

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3
Q

Q: What are the four phases of postoperative fever based on time of onset?

A

A: Immediate, acute, subacute, and delayed.

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4
Q

Q: What is the first step in evaluating a patient with postoperative fever?

A

A: Perform an ABCDE assessment to determine if the patient is stable or unstable.

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5
Q

Q: What are the immediate steps for managing an unstable patient with postoperative fever?

A

A: Secure the airway, provide supplemental oxygen, establish IV access, start IV fluids if tachycardia and hypotension are present, monitor vitals, and examine the surgical site.

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6
Q

Q: What should be done first for a stable patient with postoperative fever?

A

A: Obtain a history and physical examination, and perform labs like CBC.

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7
Q

Q: What might cause fever in the immediate postoperative period (within 24 hours)?

A

A: Physiologic causes, acute transfusion reaction, or adverse drug reaction.

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8
Q

Q: What are common findings in a physiologic fever after surgery?

A

A: Transient fever, mild leukocytosis, often self-limited.

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9
Q

Q: What should be suspected if a patient has a personal or family history of transfusion reaction or drug allergy and develops a fever?

A

A: Acute transfusion or drug reaction.

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10
Q

Q: Which tests should be ordered if an acute transfusion or drug reaction is suspected?

A

A: CBC, CMP, chest x-ray, urinalysis, and a Coombs test.

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11
Q

Q: What are the causes of fever in the acute phase (postoperative days 1 to 7) summarized by the “5 Ws”?

A

A: Wind (pulmonary issues), water (UTI), wound (surgical site infection), walking (vascular causes), and wonder drugs (drug fever).

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12
Q

Q: What should be included in a “fever workup” during the acute phase?

A

A: Chest x-ray, urinalysis, CBC, and blood cultures.

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13
Q

Q: What conditions are referred to by “wind” in the acute phase?

A

A: Atelectasis or pneumonia.

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14
Q

Q: What timeframe is typical for “water” (postoperative UTI) to develop?

A

A: Postoperative days 3 to 5.

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15
Q

Q: How does a superficial surgical site infection (SSI) typically present?

A

A: Pain around the skin incision with erythema, edema, and tenderness on exam.

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16
Q

Q: What are the signs of a deep surgical site infection?

A

A: Abdominal pain, leukocytosis, and possible fluid collection seen on CT.

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17
Q

Q: What is indicated by “walking” in the acute phase?

A

A: Vascular causes like DVT, phlebitis, or central line infection.

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18
Q

Q: What is drug fever and when does it typically present?

A

A: Fever due to medications, presenting most often subacutely after postoperative day 7.

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19
Q

Q: What are key diagnoses to consider during the subacute phase (postoperative weeks 1 to 4)?

A

A: Anastomotic leak and Clostridium difficile (C. diff) infection.

20
Q

Q: What symptoms suggest an anastomotic leak after abdominal surgery?

A

A: Abdominal pain, nausea, vomiting, bowel changes, and signs of peritonitis.

21
Q

Q: What should be ordered if an anastomotic leak is suspected?

A

A: CT of the abdomen and pelvis.

22
Q

Q: What are signs of a Clostridium difficile (C. diff) infection?

A

A: Watery diarrhea, colicky abdominal pain, and sometimes nausea and vomiting.

23
Q

Q: What tests should be ordered if C. diff infection is suspected?

A

A: Stool culture.

24
Q

Q: What is considered a delayed postoperative fever?

A

A: Fever presenting more than 30 days after surgery.

25
Q

Q: What are the common causes of delayed postoperative fever?

A

A: Community-acquired infections, device or prosthesis infection, and fistula formation.

26
Q

Q: What should be suspected if there is erythema, edema, and tenderness around an implanted device?

A

A: Device or prosthesis infection.

27
Q

Q: What is indicated by foul discharge or bleeding from a visible tract opening post-surgery?

A

A: Fistula formation.

28
Q

Q: What can cause more rapid presentation of postoperative fever and infections?

A

A: Contamination during surgery, aggressive pathogens, or undiagnosed systemic infections like COVID-19.

29
Q

Q: What is the most common cause of fever within the immediate postoperative period?

A

A: Physiologic response to surgery.

30
Q

Q: What imaging is used to confirm a diagnosis of atelectasis or pneumonia?

A

A: Chest x-ray.

31
Q

Q: What indicates a possible acute transfusion or drug reaction?

A

A: Personal/family history of reactions, recent blood products or medications.

32
Q

Q: What tests should be ordered for suspected transfusion or drug reactions?

A

A: CBC, CMP, chest x-ray, urinalysis, and Coombs test.

33
Q

Q: How do deep surgical site infections typically present?

A

A: Abdominal pain, leukocytosis, fluid collection on CT.

34
Q

Q: Immediate Postoperative Fever: Time, Clinical Features, Diagnosis, Treatment

A

Time: Within 24 hours post-surgery
Clinical Features: High levels of tissue trauma, transient fever, mild leukocytosis
Diagnosis: CBC, chest x-ray, urinalysis to rule out other causes
Treatment: Usually self-limited; supportive care

35
Q

Q: Acute Transfusion Reaction: Time, Clinical Features, Diagnosis, Treatment

A

A:

Time: Within 24 hours post-surgery
Clinical Features: Fever, flushing, skin rash, angioedema, respiratory distress, hypotension
Diagnosis: CBC, CMP, chest x-ray, urinalysis, Coombs test
Treatment: Notify blood bank, stop transfusion, supportive care

36
Q

Q: Drug Reaction: Time, Clinical Features, Diagnosis, Treatment

A

A:

Time: Within 24 hours post-surgery
Clinical Features: Fever, flushing, rash, angioedema, respiratory distress
Diagnosis: CBC, CMP, chest x-ray, urinalysis (normal findings)
Treatment: Stop the offending drug, supportive care

37
Q

Q: Wind (Atelectasis/Pneumonia): Time, Clinical Features, Diagnosis, Treatment

A

A:

Time: Postoperative days 1-2
Clinical Features: Dyspnea, cough, decreased O2 saturation, pulmonary crackles
Diagnosis: Chest x-ray (opacification, consolidations), CBC
Treatment: Incentive spirometry, chest physiotherapy, antibiotics if pneumonia

38
Q

Q: Water (UTI): Time, Clinical Features, Diagnosis, Treatment

A

A:

Time: Postoperative days 3-5
Clinical Features: Urinary frequency, dysuria, lower abdominal pain, suprapubic tenderness
Diagnosis: Urinalysis (nitrites, leukocyte esterase, bacteriuria), urine culture, CBC
Treatment: Antibiotics based on urine culture results

39
Q

Q: Wound (Surgical Site Infection): Time, Clinical Features, Diagnosis, Treatment

A

A:

Time: Postoperative days 5-7
Clinical Features: Pain around incision, erythema, edema, tenderness, fluctuant mass if abscess
Diagnosis: Ultrasound (superficial SSI), CT (deep SSI), CBC
Treatment: Antibiotics, drainage if abscess, possible surgical debridement

40
Q

Q: Walking (DVT/Phlebitis/Central Line Infection): Time, Clinical Features, Diagnosis, Treatment

A

A:

Time: Postoperative day 5 and beyond
Clinical Features: Unilateral limb swelling, erythema, redness at IV site, sepsis signs for central line infection
Diagnosis: Ultrasound for DVT, CBC, blood cultures for central line infection
Treatment: Anticoagulation for DVT, remove infected central line, antibiotics

41
Q

Q: Wonder Drugs (Drug Fever): Time, Clinical Features, Diagnosis, Treatment

A

A:

Time: Typically after postoperative day 7
Clinical Features: Persistent fever after ruling out other causes
Diagnosis: Diagnosis of exclusion
Treatment: Discontinue the offending drug, supportive care

42
Q

Q: Anastomotic Leak: Time, Clinical Features, Diagnosis, Treatment

A

A:

Time: Postoperative weeks 1-4
Clinical Features: Abdominal pain, nausea, vomiting, bowel changes, peritonitis signs
Diagnosis: CT of the abdomen and pelvis (free fluid, extravasation of contrast), CBC
Treatment: Surgical intervention, antibiotics, supportive care

43
Q

Q: Clostridium difficile (C. diff) Infection: Time, Clinical Features, Diagnosis, Treatment

A

A:

Time: Postoperative weeks 1-4
Clinical Features: Watery diarrhea, colicky abdominal pain, nausea, vomiting
Diagnosis: Stool culture, CBC
Treatment: Antibiotics (e.g., metronidazole, vancomycin), hydration

44
Q

Q: Device or Prosthesis Infection: Time, Clinical Features, Diagnosis, Treatment

A

A:

Time: More than 30 days post-surgery
Clinical Features: Pain, erythema, edema around implantation site
Diagnosis: Ultrasound (superficial), CT (deep), CBC, blood cultures
Treatment: Removal of infected device, antibiotics

45
Q

Q: Fistula Formation: Time, Clinical Features, Diagnosis, Treatment

A

A:

Time: More than 30 days post-surgery
Clinical Features: Foul discharge, bleeding from tract, erythema, tenderness
Diagnosis: Ultrasound, CT, culture of discharge
Treatment: Surgical repair, antibiotics

Surgery (33 decks)

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