Pyrexia and delirium Flashcards
Post op infection sources and tines
Infection
Day 1-2 – consider a respiratory source
Day 3-5 – consider a urinary tract source
Day 5-7 – consider a surgical site infection or abscess/collection formation
Any day post-operatively – consider infected IV lines or central lines as a source
post op causes of pyrexia
Iatrogenic – drug-induced reaction (e.g. antibiotics or anaesthetic agents) or from a transfusion reaction.
Venous thromboembolism – rare - PE or DVT can cause a low grade fever
Secondary to prosthetic implantation – foreign body
Pyrexia of Unknown Origin
Pyrexia of Unknown Origin
Recurrent fever (>38) persisting for >3wks without an obvious cause, despite >1wk of inpatient investigation
Investigations for pyrexia
Sepsis screening
Blood tests– FBC, CRP, U&Es.
Urine dipstick
Cultures– blood, urine, sputum, and wound swab
Imaging– Chest X-ray
If source of infection cannot be identified
CT scan - anastomotic leak
Doppler USS - DVT
Management of pyrexia
Look for non - infectious causes
Abx
Fluids
Lower Respiratory Tract abx
Co-Amoxiclav 5 days
Lower Urinary Tract abx
Trimethoprim 3 days
Upper Urinary Tract abx
Co-Amoxiclav 14 days
Surgical Site or Cellulitis abx
Flucloxacillin 5 days
IV line
(Central Line) abx
Flucloxacillin 5 days
Intra-Abdominal
Cefuroxime IV
Metronidazole IV
Septic Arthritis
Flucloxacillin IV
Unknown source
Cefuroxime IV
Metronidazole IV
Gentamycin STAT
Delirium
Acute confusional state
Disturbed consciousness and reduced cognitive function
Classifications of delirium
Hypoactive delirium (most common) – lethargy and reduced motor activity
Hyperactive delirium –agitation and increased motor activity
Mixed agitation – fluctuations throughout a day
Risk factors for delirium
Age >65yrs
Multiple co-morbidities
Underlying dementia
Renal impairment
Male gender
Sensory impairment (hearing or visual)
Post op causes of delirium
Hypoxia
Infection (commonly UTI or LRTI)
Drug-induced (benzodiazepines, diuretics, opioids, or steroids)
Drug withdrawal (alcohol or BZNs)
Dehydration or pain
Constipation or urinary retention
Electrolyte abnormalities (e.g. hyponatraemia, hypernatraemia, or hypercalcaemia)
Assessment of delirium
Collateral history
- onset
- symptoms
- comorbidities
- previous episodes
- DHx
AMT/MMSE
Confusion screen
Bloods – FBC, U&Es + Ca2+,TFTs, and glucose
B12 and folate
Blood cultures and / or wound swabs
Urinalysis and/or CXR
CT head (only if relevant)
Management of delirium
Treat underlying cause
- abx - infection
- oxygen - hypoxic
- laxatives - constipated
Nursed in appropriate environment
Fluids - orally
Analgesia
Monitor bowels
Haloperidol sedative - used sparingly
Environment
Quiet area
Regular routine
Clocks to orientate to time and place)
Regular sleeping patterns
