Post-Operative Fever

Happy Monday, and welcome to Medical Mondays!

I had all these grand plans to make most Medical Mondays pertinent health-month-related topics, but…I gotta study. It is crunch time! (Nooo!) A whole lot of the topics that I planned to write about have been shunted over to…2016.

Anyone wanna hazard a guess as to how many drafts I have piled up on this blog thus far?! (I’ll give you a hint–it’s more than 100.)

I’m gonna talk at you about Post-Operative Fever today, because I wrote this whilst on my surgery rotation! It’s one of the things we’re always on the lookout for after we’ve operated on a patient, and this is where a super-handy mnemonic (the basis of how I memorized/learned most things in anatomy back in the day) comes into play!

Post-op fever can be caused by malignant hyperthermia, a potentially fatal disorder that’s associated with the administration of certain anesthetic agents.

Malignant hyperthermia classically presents with a high fever (typically >104 F) shortly after an anesthetic is given, and is generally treated with IV dantrolene, 100% O2, and cooling blankets.

Bacteremia is a cause of fever within hours of a surgery, and blood cultures/empiric antibiotics should be ordered.

The Five “W’s”

• Wind – These usually occur the earliest, on post-op days 1-3
  • Atelectasis (the complete or partial collapse of a lung or lobe of a long) is the most common, and is treated with coughing, deep breathing, ambulation + incentive spirometry; most common on days 0-1
  • Pneumonia is usually suspected when an initial fever on post-op day 0-1 persists for 2-3 days
  • Pulmonary issues can also be associated with fever; these are usually related to pre-existing pulmonary dysfunction coupled with the incisional pain, respiratory depression from narcotics, and abdominal distention
• Water (UTIs, pyelonephritis)
  • UTIs usually present between post-op days 3-5, often after bladder catheterization
    • UTI = 3 letters => “day 3”
• Walking (DVTs, aka blood clots)
  • Deep venous thrombosis (DVTs) or phlebitis usually start in the lower extremities + can involve more proximal veins; check for edema in the legs!
  • Pulmonary embolisms can be associated with fever
  • Can occur at any time postoperatively, but often in post-op days 4-6
• Wound (infection)
  • Usually occur on post-op days 5-8 (only strep + clostridial wound infections cause fever earlier than this).
  • First step in treatment is typically to remove the staples in order to allow fluid to drain
• Wonder drugs (pretty much any kind of drug, but most commonly antibiotics or heparin)
  • Usually presents on post-op day >7

General Management

1. Daily examination of the patient (or more frequent if necessary), including the surgical wound
2. Removal of surgical tubes as soon as possible
3. Early ambulation, to prevent elevated risk of blood clots
   
4. Close monitoring of fluid balance + electrolyte levels
5. Adequate but not excessive pain medication/management

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Disclaimer: This is where I reiterate that I am merely a medical student struggling through the world that is her clinical rotations. The statements made on this blog should not be taken as medical advice to treat, cure or prevent any disease. Please contact your own physician or health care provider before starting a health or fitness/wellness program. (See full disclaimer here.)