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

By TeachMeSurgery (2020)

Fig 1
The 5 Ws.