The Patient with Post-Operative Fever

Key Points to Remember

  • Ask yourself “Is this patient really sick? Or do they look well” and check their observations
  • If they look sick, assess the patient in an ABCDE approach
    • Look at the bedside observations, recent blood results and previous microbiology. Does the patient fulfil SIRS criteria?
    • Give oxygen (as determined by O2 saturations),
    • Get IV access early on
    • Take blood to send for FBC, CRP, U&Es, LFTs, Clotting, amylase and a VBG (for a lactate). Also send off blood cultures.
    • Give fluid challenge (20-30ml/Kg of crystalloid) if any sign of shock
    • Take a brief history of the presenting features during resuscitation, including for a potential source of sepsis
  • With a septic patient aim for a urine output of >0.5/mls/kg/hr and repeat the plasma lactate within an hour to make sure that things are going in the right direction.
  • Remember the 5 W’s (Wind, Water, Walking, Wound, Wonder Drugs) as causes of a post-operative fever
  • If you suspect an infection, focus on the potential source
    • If you suspect the chest, get a chest x-ray and send a sputum sample to the lab
    • If you suspect the urine, perform a urine dip and send a midstream sample to the lab
    • Examine the wound for signs of infection and send wound swabs for culture
  • Check your local antibiotics policy to choose the most appropriate antibiotic.
    • When prescribing antibiotics start SMART then FOCUS as you obtain the results of microbiology
Fig 1 - The 5 Ws.

Fig 1 – The 5 Ws.

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