Ahhh Crap! My Patient has Post Operative Fever!
Posted On Feb 2, 2009 at at 12:46 PM by EducatedNobodyPost operative fever is temperature above 38.5 Celcious or 101.5 farenheight
Post Op Fever 5 W’s and a Basic Diagnostic Plan
Pre 24 hour fever- Early atelectasis, wound infected by B-haemolytic strep or cloistridium, anastomtic leak.
Wind – Is this atelectasis or Pneumonia? First 24- 48 hours
Wind – Is this atelectasis or Pneumonia? First 24- 48 hours
Water – Is this a Urinary Tract infection? Anytime after post op day 3
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.
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.
Basic Diagnostic Plan
CXRBlood cultures (two sets differnt locations)
Urine analysis, Culture and sensitivity
Other images needed?
Where the hell could this infection be coming from?
Central line?Foley catheter?
Pulmonary emboli?
Heparin lock or IV?
Urinary tract?
Patients wound?
Heart Valves?
(you can always call you local microbiologist)
Out of ideas...What the hell should I do next?
Antibiotics (but wait!)?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?
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