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To: koan who wrote (45823)	7/27/2007 11:17:53 PM
From: E. Charters	Read Replies (1) \| Respond to of 78426

nah... sounds like you have low grade infection due to your op. could anti-bis are not kicking in. Avoid eating meat. I would inform physician immediately if not sooner and get it diagnosed. You want to avoid septicemia etc.. could lead to pleurisy. 98.6 is only an average of course. But if you are feeling any sort of fever, I would show appropriate concern. BTW fevers do not always have to have hight temp. For most of my life I got cold fevers. Low temperatures and surging fever with extreme weakness and malaise. It was always lung related. stacommunications.com Wind In the first 24 hours after an operation, 27% to 58% of patients may develop fever. Most of these cases, which are likely due to atelectasis, are of little concern unless associated with systemic signs, such as rigors, altered mentation, or hypotension. Pneumonia may occur several days post-surgery and is an important diagnosis to consider if systemic signs are present; it is also important to question the presence of a ventilator-associated pneumonia after prolonged intubation. Water The patient has an increased risk of developing cystitis the longer a urethral catheter is in place. The catheter should be removed as soon as the patient is able to mobilize, or use a urinal. Wound It is important not to miss something nefarious, like a necrotizing fasciitis or an intestinal leak, especially post-surgery. A cellulitis may be present *********************************** Infection by onset time: Day One—Local causes • Atelectasis • Wound cellulitis • Urinary tract infection • Indwelling catheter infection • Transfusion reaction • Drug fever • Thrombophlebitis • Surgical complications Day Two—Respiratory/Catheter causes • Pneumonia • Urinary tract infection • Wound cellulitis • Necrotizing fasciitis or clostridial myositis Day Three—Systemic causes • Thrombophlebitis • Deep vein thrombosis Wound infection • Cholecystitis • Pancreatitis • Systemic bacteremia/fungemia/viremia** Day Seven and on—Surgical complications, undiagnosed disease • Leaking anastomosis • Infected prosthetic material • Deep wound infection • Abscess • Deep vein thrombosis or thrombophlebitis • Clostridium difficile diarrhea • Collagen/Vascular disease • Occult bacteremia • Neoplasm Any bone cutting is always very susceptible to infect. I always insisted to drs. that I get anti-bis when I cut to the bone with an axe. Without fail within 3 days I would get a fever and sure enough it was an infection. One time I had to point out the bone cut to dr. on the x-ray. It was a sigmoidal dark gash on the shin bone. She was confused because it was not directly below the cut. Axe wounds always travel sideways under the muscle and nick the bone about an inch away or less from the flesh cut. Infection thru clothes still happens when the bone is cut. Only cut twice to the bone and did not infect. One was a knee op, and took routine anti-bis for two weeks after. Another was knife wound in the arm. Cut 4 times to bone with axe in explo and always infected after. Sap adheres to ax and breed bugs. Too sticky to wipe clean when penetrating clothes. A round of cloxicillin should clear up such incipient infection if started early. BTW animal bite thru clothes rarely infect. Cloth wipes teeth completely clean 98% of the time. Good news is a routine of cloxycillin should clear it up. If it necrotizing fasciitis, then it has been good to know you. kent-exploration.com Just trying to cheer you up and make your weekend wonderful. The symptoms of flesh-eating disease include a high fever, and a red, severely painful swelling that feels hot and spreads rapidly. The skin may become purplish and then die. There may be extensive tissue destruction. Sometimes the swelling starts at the site of a minor injury, such as a small cut or bruise, but in other cases there is no obvious source of infection. The infection begins locally, at a site of trauma, which may be severe (such as the result of surgery), minor, or even non-apparent. The affected skin is classically, at first, very painful without any grossly visible change. With progression of the disease, tissues becomes swollen, often within hours. Diarrhea and vomiting are common symptoms as well. Inflammation doesn't show signs right away if the bacteria is deep within the tissue. If it isn't deep, signs of inflammation such as redness, swollen and hot skin show very quickly. Skin color may progress to violet and blisters may form, with subsequent necrosis (death) of subcutaneous tissues. Patients with necrotizing fasciitis typically have a fever and appear very ill. More severe cases progress within hours, and the death rate is high, about 30%. Even with medical assistance the antibiotics take a while to react to the bacteria making the infection even more serious.[1] EC<:-}

To: koan who wrote (45823)	7/27/2007 11:28:37 PM
From: E. Charters	Respond to of 78426

It is important to elicit the timeline associated with the fever. Key questions to ask are: • When was the surgery? • What type of procedure was performed? • Are there pre-existing or implanted prostheses involved? • What and when was peri-operative antibiotic prophylaxis given? • When did symptoms begin? • Were any symptoms present prior to surgery? • Were there any complications with the surgery, or a prolonged hospital stay? • Does the patient have pre-existing medical conditions that could predispose to fever? • Were there blood products given? A thorough review of systems, including respiratory, genitourinary, gastrointestinal, neurologic, and cardiac is necessary. Physical examination should include the respiratory, cardiovascular, urinary, and gastrointestinal systems, as well as a thorough examination of the skin. An examination of the peripheral or central sites that were used for vascular access is also important, as an infected hematoma or thrombophlebitic vein may be present. Lastly, a thorough inspection of the wound site is imperative. • Is there a fluctuant mass palpable? • Is redness or heat present surrounding the incision? • Is there a surrounding wound cellulitis that may or may not be well demarcated? • Is pain present?

To: koan who wrote (45823)	7/27/2007 11:30:33 PM
From: E. Charters	Read Replies (1) \| Respond to of 78426

Watch for pain, dark veins, swelling, hot feeling at wound site. It could be however just "drug fever". It is important to always consider a latent infection in neurosurgical, orthopedic, and cardiac procedures. A thorough review of the patient's medications is prudent, as it is important not to overlook a "drug fever" associated with the commencement of a new medication. Antibiotics themselves may lead to drug fevers and should not be started unless absolutely necessary. It is also important to remember that antibiotics may cause Clostridium difficile associated disease, which may manifest with fever, abdominal pain, and diarrhea. *****************************