QuestionSBA
QuestionChoice
This patient is not wheezy and the history does not suggest an asthma/COPD exacerbation. This is unlikely to improve the clinical picture.
10015688
c
Give STAT salbutamol nebulisers
QuestionChoice
The history does not describe acute abdomen or other concerning features that could be addressed by a return to theatre such as peritonitis or abdominal distension.
10015689
d
Immediate return to theatre for emergency surgery
QuestionChoice
Although pneumonia could cause shortness of breath, there is no history of a cough or fever, or description of crackles. Whilst a CXR would definitely be sensible, starting antibiotics based on this presentation alone would not be appropriate.
10015690
e
Commence clarithromycin 500mg BD PO
QuestionChoice
Whilst sudden onset SOB in a post operative patient  should always lead to consideration of PE, the Well’s score in this case is 1.5, which means an initial d-dimer would be more appropriate than going straight to a CTPA. Additionally, the examination findings would be inconsistent with the diagnosis of PE.
10015687
b
Arrange a CTPA
QuestionChoice
This describes atelectasis, small areas of collapse which often occur following abdominal surgery due to pain on deep breathing and coughing, leading to incomplete clearing of secretions. This is usually managed conservatively at first, with chest physiotherapy and pain relief to allow proper clearing of secretions.
10015686
a
Chest physiotherapy and optimise pain control
QuestionComment
5W’s- got this from Grey’s anatomy 😁
35830
QuestionComment
how do you know she had a fever? doesn't say in Q
39157
User
subscriber
Botox Haemophilus
QuestionComment
SoB within 72 hours of surgery, with no signs of DVT/PE. Likely atelectasis = Chest physiotherapy, and position upright
41325
User
subscriber
Respect
User
subscriber
Z-line JAK
QuestionComment
i thought atelectasis would cause hypoxia? 
45857
User
subscriber
Dominant Serotonin
Concept
Chapter
# Summary

Post-operative pyrexia, or fever following surgery, can be the result of several causes, commonly remembered by the "5 Ws" mnemonic: Wind (pneumonia and atelectasis), Water (urinary tract infection), Wound (infection), Wonder drugs (anesthetic reactions), and Walking (deep vein thrombosis). Timelines for the emergence of these causes can vary, but are typically seen within specific post-op periods. It's essential to recognize these symptoms promptly, carry out the relevant investigations such as cultures, imaging, or blood tests, and initiate appropriate management like antibiotics, anticoagulants, or potentially further surgical intervention.

# Definition

Post-operative pyrexia refers to the development of fever following a surgical procedure, usually classified as a core body temperature above 38 degrees Celsius.

# Epidemiology

Post-operative pyrexia is a common occurrence, especially in the first 48 hours post-surgery due to the systemic inflammatory response. The incidence can vary based on the type and invasiveness of the surgery, patient characteristics, and the perioperative care quality.

# Aetiology

Causes of post-operative pyrexia can be remembered using the **5 Ws** mnemonic:

-   **W**ind: Pneumonia and atelectasis (1-2 days post-op)
-   **W**ater: Urinary tract infection (UTI) (>3 days)
-   **W**ound: Surgical site infections (> 5 days)
-   **W**onder drugs: Drug-induced fever, commonly due to anaesthesia
-   **W**alking: Deep vein thrombosis (DVT) (>1 week)

In addition to these, a developing abscess post-operatively can also cause pyrexia.

# Signs and Symptoms

-   **Pneumonia and atelectasis**: Cough, dyspnea, sputum production, chest pain, decreased breath sounds on examination
-   **Urinary tract infection (UTI)**: Dysuria, urgency, frequency, suprapubic pain, foul-smelling urine
-   **Surgical site infections**: Pain, erythema, swelling at the wound site, purulent discharge
-   **Drug-induced fever**: Fever associated with recent drug use, but typically no other localized symptoms
-   **Deep vein thrombosis (DVT)**: Leg pain, swelling, erythema, warmth

# Differential Diagnosis

-   **Non-infectious causes of fever**: These could include malignancy, collagen vascular disease, thromboembolism, or medication effects. Main symptoms might include widespread symptoms with no localized signs.
-   **Infection not associated with surgery**: Infections elsewhere in the body may cause fever post-operatively. The signs and symptoms would correspond to the organ system affected.
-   **Abscess formation**: This would typically present with localized signs of infection (redness, pain, swelling) at the site of the abscess.

# Investigations

Investigations will depend on the suspected underlying cause. They may include:

-   **Blood tests**: Full blood count, CRP, blood cultures
-   **Cultures**: Urine, wound, or sputum cultures as applicable
-   **Imaging**: Chest X-ray, CT scan, or ultrasound depending on the suspected site

# Management

The management of post-operative pyrexia depends on the underlying cause but could include:

-   **Antibiotics**: For bacterial infections like pneumonia, UTI, or wound infections
-   **Anticoagulants**: For DVT
-   **Modification or cessation of the offending drug**: For drug-induced fever
-   **Further surgical intervention**: In case of abscess formation or severe wound infection
732
837
Post-operative pyrexia
Topic
7
General Surgery
15681
Post-operative atectasis following abdominal surgery is often managed initially with chest physiotherapy and pain control to facilitate clearance of secretions.
Presentation
456
Post-surgical care and complications
UkmlaTopic
1
Acute and emergency
Presentation
457
Post-surgical care and complications
UkmlaTopic
21
Perioperative medicine and anaesthesia
Presentation
458
Post-surgical care and complications
UkmlaTopic
25
Surgery
A 47 year old female has shortness of breath 2 days after her subtotal colectomy. She has reduced air entry in both lung bases and a slightly elevated respiratory rate with normal oxygen saturations. Her calves are soft and non tender.

Given the likely diagnosis, what is the most appropriate management option?
a