Nosocomial (Surgical Site, Lines, Chest, Urine, Sinusitis)

10/4/11 Examinations Book

GENERAL APPROACH

Infectious - community acquired - nosocomial (surgical site, lines, chest, urine, sinusitis)

Non-infectious - head injury - DVT -> PE - drug/toxin - SIRS (post surgery, trauma, aspiration, pancreatitis) - Hypermetabolic syndromes -> thyroid storm -> NMS -> MH -> heat stroke -> phaeo -> liver failure -> burns -> cocaine toxicity -> serotonin syndrome

INTRODUCTION

CUBICLE

- isolation (MDRO) - long stay patient (new problem -> nosocomial infection)

INFUSIONS

- antibiotics (MDRO) - noradrenaline (sepsis) - heparin (DVT -> PE) - blood products (febrile reactions)

VENTILATOR

- level of support - level of oxygenation (FiO2, PEEP) - disease specific questions (ARDS: plateau pressure, bronchospasm: dynamic hyperinflation, intrinsic PEEP)

MONITOR

Jeremy Fernando (2011) - temperature - tachycardia (SIRS) - ETCO2 (hypermetabolic syndrome) - CVP (number, waveform) - arterial trace (pressure, swing, pulsus paradoxus)

EQUIPMENT

- intra-abdominal drains (fluid, amount) - EVD (recent cell count and culture) - rectal tube (diarrhoea) - active cooling (severe hyperthermia) - epidural (inspect site and examine neurology) - intercostals drains (number, bubbling, drainage) - urine (colour, output, myoglobin, microscopy)

QUESTION SPECIFIC EXAMINATION

- hands/arms -> head -> chest -> abdo -> legs/feet -> back -> cardiovascular -> respiratory -> abdominal -> haematological

- neurological -> paralysed -> quick examination -> unconscious -> conscious

- vaginal examination for retained tampon - age of lines - recent anaesthetics (MH) - recent antibiotic exposure (drug fever)

RELEVANT INVESTIGATIONS

- CXR - FBC: WCC - microbiology: sputum, blood cultures, urine, line cultures, intra-abdominal samples - burn biopsy

OPENING STATEMENT

My Approach to fever in this patient is to look at Infectious and Non-infectious causes

I believe that this patient has multiple possible causes for fever:

List headings of causes -> clinical signs associated with list

Jeremy Fernando (2011)