Chapter 27: Fever

Question 1

Define postoperative fever

Answer 1

Temperature >38.5°C or 101.5°F

Question 2

What are the five classic W’s of postoperative fever?

Answer 2

1. Wind—atelectasis
2. Water—urinary tract infection (UTI)
3. Wound—wound infection
4. Walking—DVT/thrombophlebitis
5. Wonder drugs—drug fever

Question 3

Give the classic postoperative timing for the following causes of postoperative fever:

Atelectasis (Wind)

Answer 3

First 24 to 48 hours

Question 4

Give the classic postoperative timing for the following causes of postoperative fever:

UTI (Water)

Answer 4

Anytime after POD #3

Question 5

Give the classic postoperative timing for the following causes of postoperative fever:

Wound infection (Wound)

Answer 5

Usually after POD #5 (but it can be anytime!)

Question 6

Give the classic postoperative timing for the following causes of postoperative fever:

DVT/PE/thrombophlebitis (Walking)

Answer 6

PODs #7 to #10

Question 7

Give the classic postoperative timing for the following causes of postoperative fever:

Drug fever (Wonder drugs)

Answer 7

Anytime

Question 8

What is the most common cause of fever on PODs #1 to #2?

Answer 8

Atelectasis (most likely cytokine release from tissue damage!)

Question 9

What is a “fever” workup?

Answer 9

• Physical exam (look at wound)
• CXR
• urinalysis
• blood cultures
• CBC

Question 10

What causes fever before 24 postoperative hours?

Answer 10

• Atelectasis
  
  • cytokine release
  • β-hemolytic streptococcal or clostridial wound infections
  • anastomotic leak

Question 11

What causes fever from PODs #3 to #5?

Answer 11

• UTI
• pneumonia
• IV site infection
• wound infection

Question 12

What is an anesthetic cause of fever INTRAoperatively?

Answer 12

Malignant hyperthermia—treat with dantrolene

Question 13

What causes fever from PODs #5 to #10?

Answer 13

• Wound infection
• pneumonia
• abscess
• infected hematoma
• Clostridium difficile colitis
• anastomotic leak
• DVT
• peritoneal abscess
• drug fever
• PE
• abscess
• parotitis

Question 14

What causes wound infection on PODs #1 to #2?

Answer 14

• Streptococcus
• Clostridia (painful bronze-brown weeping wound)

Question 15

What can cause fever at any time?

Answer 15

• IV site infection
• Central line infection
• Medications

Question 16

38-year-old female diabetic with cellulitis on broad-spectrum antibiotics for 2 weeks develops fever, massive diarrhea, and abdominal pain

Answer 16

C. difficile colitis

Question 17

27-year-old woman who following menses develops rash,hypotension, and fever

Answer 17

Toxic shock syndrome