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WorksheetsSurgical Problem & Procedures: General Surgery Fever
Total questions: 41
Worksheet time: 21mins
Mechanism sequence of Fever? POA=Preoptic Area AH=Anterior Hypothalamus
IL-1 → PGE-1,PGE-2 → POA/AH → ↑ Body Temperature
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Normal body temperature?
98.6° − 100.4°
102.2°−104.0°
100.5°−107°
How does the hypothalamus raise body temperature?
Increases muscle tone, shivering, and hormones like epinephrine and prevent heat loss by vasoconstriction
Decreases muscle tone and hormones like epinephrine and prevent heat loss by vasdodilation
What is considered a mid grade fever?
102.2°−104.0°
98.6°−100.4°
What is considered hyperpyrexia?
>107.6
>98.6
<98.6
<105.0
When is otic temperature considered a fever?
>98.0
>99.0
>105.0
>107.0
The W's of fever?
Wind/Water = lung disease, UTI's
Walking = DVT
Wound = Infection
Wonder Drugs = Drug Rxn
What Else = Devices (valve, catheter, foley, lines)
Post Op Day 0 fever (0-24 hours) causes?
Systemic Response to surgery or pre-existing condition
Atelectasis, Pneumonia
Invasive instruments
DVT/PE
Post Op Day 1-3 fever (24-72 hours) causes?
Systemic Response to surgery or pre-existing condition
Atelectasis, Pneumonia
Invasive instruments
DVT/PE
Post Op Day 3-7 fever causes?
Wound Infection, IntraAbdominal Collection, Anastomotic Leak, UTI, Phlebitis, Cholecystitis, Prostatitis
Atelectasis, Pneumonia
Invasive instruments
DVT/PE
Post op Day 5-7 fever causes?
Systemic Response to surgery or pre-existing condition
Atelectasis, Pneumonia
Invasive instruments
Post op day 7-10 fever causes?
DVT/PE
Invasive Instruments
Atelectasis
What is the MOST COMMON cause of post operative fever?
DVT
PE
Atelectasis
Pneumonia
Atelectasis treatment?
Mobilize patient, incentive spirometry, pain control, pulmonary toilet, Chest Physiotherapy, EzPAP, Bronchodilators
Fine Needle Aspiration and Chest tube placement
What patients are at highest risk for development of thromboembolism?
Tonsillectomy
Thyroid Procedures
Orthopedic Procedures
Presentation of DVT? Presentation of PE?
DVT: Leg Pain, Edema, Homan's (+),
PE: Tachycardia, Tachypnea, Chest Pain, Hypoxemia
DVT: Tachycardia, Tachypnea, Chest Pain, Hypoxemia
PE: Leg Pain, Edema, Homan's (+),
Diagnosis of PE? Diagnosis of DVT?
DVT: Doppler U/S
PE: Doppler U/S
PE: CT Angiogram
DVT: CT Angiogram
Treatment of DVT? Treatment of PE?
DVT: Anticoagulants, IVC filter if unable to Anticoag
PE: Anticoagulants, IVC filter placement
DVT: Anticoagulants, IVC filter placement
PE: Anticoagulants, IVC filter if unable to Anticoag
Fever when catheter in place, one should suspect?
Sepsis (>48 hours of catheter in place)
Normal reaction
Diagnostic criteria for sepsis due to catheter?
2 blood samples + catheter tip required
catheter tip alone
Pathogens related to catheter related blood stream infection?
S. Aureus/MSSA
S. Epidermidis
Strep Viridans
Strep Pneumo
Tx for catheter related sepsis?
Remove Catheter (1st thing!!!)
Antibiotics, but Vancomycin should be started util MRSA ruled out!
Thrombophlebitis findings and treatment?
Painful, palpable cord
Cellulitis
Treatment is remove IV, Limb elevation, hot packs and Antibiotics
Excision of peripheral vessel OR Heparin if Central vessel involved
Catheter related UTI/Urosepsis pathogens?
E. Coli
Pseudomonas
Enterococcus
H. Flu
Treatment for Catheter related UTI?
REMOVE CATHETER FIRST!!
Antibiotics depending on special circumstances and clinical state of patient
Use VANCOMYCIN empirically
Nosocomial sinusitis can be seen with?
Nasogastric Tubes/NT Tubes
Nasal Packing
Diagnosis of nosocomial sinusitis?
Sinus puncture and isolation
>10 CFU's of pathogen
Necrotizing wounds pathogens involved?
Clostridia
β−hemolytic strep
Treatment of necrotizing wounds?
Surgical debridement and IV Penicillin
IV Cipro
IV Gentamycin
Diagnosis of abdominal abscesses? Treatment?
CT Scan and pathogens usually enteric pathogens and anaerobes
Tx with Abx and/or Percutaneous/Surgical Drainage
IV gentamycin only
U/S for diagnosis
Diagnosis of perforated viscus (gastric/duodenal ulcer, or Diverticula)?
KUB Xray = free air below diaphragm
Tx is surgical intervention and empiric abx
U/S for dx
Tx is Gentamycin alone
Dx of clostridium difficile is made by? Treatment?
(+) C.Diff toxin in stool
Tx: Oral Vanco or Oral/IV Flagyl, Fluids
Throat culture
Tx: Clarithromycin
What is posterior fossa syndrome?
Due to RBC's in CSF, occurs after any intracranial procedures
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Labs for posterior fossa syndrome?
CSF analysis : Negative culture, Low GLucose, HIGH protein
CSF analysis : Positive culture, High GLucose, Lowprotein
Malignant neuroleptic syndrome is caused by?
Neuroleptic Agents such as haloperidol
Metamucil
Ibuprofen
Presentation of malignant neuroleptic syndrome?
Confusion, Hyperthermia (>106.0), Muscle Stiffness
Hypothermia and Muscle flaccidity
Tx of malignant neuroleptic syndrome?
Dantrolene
Cyclobenzaprine
Meloxicam
Difference between malignant neuroleptic syndrome and malignant hyperthermia? Similarity?
MNS = due to neuroleptic agents such as haloperidol
Malignant Hyperthermia = genetic disorder, caused by rxn to anesthetics and Muscle relaxants (Patient will be tachy!)
Both Treatment with Dantrolene
Blood transfusion fever is due to?
rise of antileukocyte antibodies
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Approach to fever patients?
Why Admitted? How long admitted? Any surgical interventions?
Intravascular or indwelling catheters? Labs? Immune Status?
Physical exam of febrile patient?
General Appearance, Vital Signs, Head to Toe, Dressing and Wound and IV Checks, Location and age of devices and acuity
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