SR 28 - Fever

Question 1

Define postoperative fever

Answer 1

Temp >38.5 or 101.5

Question 2

What are the classic Ws of postoperative fever?

Answer 2

Wind - atelectasis (24-48 hrs)
Water - UTI (after POD 3)
Wound - wound infection (after POD 5)
Walking - DVT/Thrombophlebitis (POD 7-10)
Where - Abscess (POD 10)
Wonder drugs (any point)

Question 3

What is a complete fever workup?

Answer 3

Physical exam (remember to look at the wound)
CXR
Urinalysis
Blood cultures
CBC

Question 4

What causes fever before 24 post-op hours?

Answer 4

Atelectasis, B-hemolytic streptococcal or clostridial wound infections, anastomotic leak

Question 5

What causes fever during POD 3-5?

Answer 5

UTI, pnuemonia, IV site infection, wound infection

Question 6

What causes fever during POD 5-10?

Answer 6

Wound infection, pneumonia, abscess, infected hematoma, C. difficile colitis, anastomotic leak
DVT, peritoneal abscess, drug fever
PE, abscess, parotitis

Question 7

What causes wound infection of POD 1-2?

Answer 7

Streptococcus

Clostridia (painful bronze-bown weeping wound)

Question 8

What is a cause of intraoperative fever?

Answer 8

Malignant hyperthermia

Treat with dantrolene

Question 9

What can cause fever at any time?

Answer 9

IV site infection
Central line infection
Medications