Ahhh Crap! My Patient has Post Operative Fever!
Posted On Feb 2, 2009 at at 12:46 PM by EducatedNobody
Wind – Is this atelectasis or Pneumonia? First 24- 48 hours
Wound – Take a peek, remove dressings if needed, is your wound infected? Anytime after post op day 5
Walking – Is this a PE? Day 7-10
Wonder drugs – check all the meds Your patient is on! Occurs anytime!
Obviously your management work up depends upon the cause of your post op fever. The work up for a PE is obviously different than draining a collection of pus. Both should be considered if your patient is not responding to your current course of antibiotics.
Blood cultures (two sets differnt locations)
Urine analysis, Culture and sensitivity
Other images needed?
Foley catheter?
Pulmonary emboli?
Heparin lock or IV?
Urinary tract?
Patients wound?
Heart Valves?
(you can always call you local microbiologist)
Culture everything first!
Blood cultures X 2
Did you culture: Urine, Sputum, all the ports of all these lines?
Do you need to give your patient more IV fluids (if your patient has fever their fluid requirements go up ya know!)
Are you still totally lost? Should you have called the infectious disease consultant 5 minutes ago?
Beware the groin, neck or antecubital “abscess”
Posted On Feb 1, 2009 at at 9:42 AM by Shifting Dullness
The surgical resident is commonly called to evaluate red, tender, fluctuant masses all over the body and often incises and drains an abscess under local anaesthesia. These masses are often numbed with ethyl chloride spray and acupressure (lignocaine doesn't work well in an acid environment and pus has a low pH) before a cruciate incision is made, the contents are evacuated, samples taken for culture and the wound is packed with a Betadine wick.
In the book, Dr. Schneider reminds readers, however, that if the mass is in the antecubital fossa, groin or neck we should consider mycotic aneurysm in our differential.
A mycotic aneursym is a localised dilatation of an artery at least 150% of its normal diameter due to destruction of the vessel wall by bacterial infection। Usually this is due to penetrating injury, most commonly in IVDUs. Dr. Fiser (ABSITE Review) says that the organism responsible is most commonly Staph. or Strep., and that empiric broad spectrum antibiotic cover (e.g. Flucloxacillin 500mg tds iv + benzyl-penicillin 1.2g qds iv) should be started.
- assessing the lesion clinically (for a pulse and bruit) and if necessary
- imaging it with Doppler ultrasound or CT angiography.
This led me on to starting the chapter on “Methods of Arresting Bleeding” in Milton T. Edgerton's very excellent “The Art of Surgical Technique”, but I haven't finished, so I'll report back on that later!
GAB
Books I Liked:
Posts
