Postop fever

Question 1

Name the 5 W’s

Answer 1

Wind - pneumonia, bowel obs/ileus (DAY 1-3)
Water - UTI (DAY 4-7)
Wound - infection @ wound (DAY 4-7)
Walking - DVT (DAYS 3-7)
Wonder drugs - drug allergies or reaction

Question 2

Physical exam for post op fever

Answer 2

Vitals: BP, pulse, temp
Lung exam: look for consolidation or atelectasis
Abd exam: distension or acute abdomen, look for wound breakdown or dehiscense
Extremities: DVT, thrombophlebitis
CVA and suprapubic tenderness: pyelonephritis/uti

Question 3

Labs for postop fever

Answer 3

CBC, Ucx/sensitivies, blood cultures, wound culture

Question 4

Imaging tests for postop fever

Answer 4

suspect pneumonia - cxr
suspect ileus or obstruction - erect abdominal xray
DVT - doppler US
suspect abscess/hematoma - pelvic US or CT abd/pelvis

Question 5

Drug fever signs

Answer 5

eosinophilia >20%
patient looks better than expected
baseline temp elevation with “hectic spikes”

Question 6

Signs of septic pelvic thrombophlebitis (SPT)

Answer 6

Fever despite abx 3-5 days, no signs of abscess (imaging negative)
often right side pain
hypercoagulablity, pelvic vein damage, venous stasis
add heparin and gets better within 48hrs