Sie sind auf Seite 1von 9
CASE BASED LEARNING POSTOPERATIVE FEVER POD# 1=Wind Dr.B.Selvaraj MS;Mch;FICS; Professor of Surgery Melaka Manipal

CASE BASED LEARNING

POSTOPERATIVE FEVER POD# 1=Wind
POSTOPERATIVE FEVER
POD# 1=Wind
Dr.B.Selvaraj MS;Mch;FICS; Professor of Surgery Melaka Manipal Medical College Melaka 75150 Malaysia
Dr.B.Selvaraj MS;Mch;FICS;
Professor of Surgery
Melaka Manipal Medical College
Melaka 75150 Malaysia
CASE BASED LEARNING
CASE BASED
LEARNING

66 years old woman underwent hemi-colectomy after a perforation due to diverticulitis.

The patient is on postoperative day 1 and complains of cough and is noted to have fever.

She was intubated for the procedure with a laryngeal mask

airway.

Vitals: BP 130/80; HR102; RR19; T 101*

O/E: Dull on percussion over LLL area; Breath sounds diminished

CASE BASED LEARNING
CASE BASED LEARNING

What is your diagnosis?

Fever in postop day 1 to 3 is due to Atelectasis or Pneumonia Mnemonic:

Wind POD # 1 to 3 Atelectasis & Pneumonia

Water POD # 3 to 5CA- UTI

Walking- POD# 4 to 8DVT & PE

Wound-POD# 5 to 7SSI

Wonder drugs- anytime Drug fever

CXR- ATELECTASIS
CXR- ATELECTASIS

What is the best next step?

- CXR- PA and lateral views

- Post-op Atelectasis

CXR- ATELECTASIS  What is the best next step? - CXR- PA and lateral views -
CXR- ATELECTASIS  What is the best next step? - CXR- PA and lateral views -
CXR- PNEUMONIA
CXR- PNEUMONIA

What is the best next step?

- CXR- PA

and lateral

views

- Post-op Pneumonia

CXR- PNEUMONIA  What is the best next step? - CXR- PA and lateral views -
CXR- PNEUMONIA  What is the best next step? - CXR- PA and lateral views -
CXR- PNEUMONIA  What is the best next step? - CXR- PA and lateral views -
Post-op fever POD#1
Post-op fever POD#1
 

ATELECTASIS

PNEUMONIA

DEFINITION

Collapse of the lung resulting in imbalance in gas exchange

Pneumonia is an inflammation of the lung tissue as a result of bacterial, viral or other infection .

ETIOLOGY

Due to hypoventilation in GA or decreased diaphragmatic movement due to surgical site pain

Complication of atelectasis or aspiration. #1 cause for postop morbidity and mortality. #3 cause for postop complications behind SSI & UTI

PRESENTATIO

Fever, tachypnea, tachycardia, dull on percussion over affected area and decreased breath sounds.

Fever, tachypnea, tachycardia, AMS & cyanosis in severe cases; Decreased breath sounds, rales & rhonchi, egophony, dullness on percussion

N

Post-op fever POD#1
Post-op fever POD#1
 

ATELECTASIS

PNEUMONIA

INVESTIGATION

CXR- opacity over affected area

CXR- opacity over affected area Sputum- C & S ABG, CBC, CRP

S

- compensatory translucency

- ILS hemidiaphragm elevation

- mediastinal shift to same side

 

ABG & Helical CT chest

TREATMENT

- Adequate pain control

- Broadspectrum antibiotics according to C&S; No role for spirometry

- Empirically anti Pseudomonal antibiotics like Ceftazidime, Piperacillin- tazobactum, Imipenum, meropenum Etc

- Incentive spirometry for prophylaxis

- Chest physiotherapy

- No need for antibiotics

- Non invasive +ve pressure

ventilation like CPAP or BiPAP

- Anti MRSA antibiotics like

Vancomycin& Linazolid

Post-op fever POD#1
Post-op fever POD#1

RISK FACTORS:

Age > 50 years

Duration of surgery > 3 hrs

Post-op GCS < 15

Duration of Post-op ETT > 48hrs

Tracheostomy

Mechanical ventilation

ICU stay > 5 days

THANK YOU
THANK YOU

Subscribe to get notified regarding my latest uploads

THANK YOU Subscribe to get notified regarding my latest uploads