This document provides information on post-operative fever, including its definition, causes, signs and symptoms, diagnostic workup, and treatment. It notes that fever developing within 24 hours of surgery is usually not due to infection, while fever developing after post-operative day 2 is usually infectious. The diagnostic workup of post-operative fever involves examination of the surgical site and other body systems, along with blood and urine cultures. Treatment is directed at the underlying cause, which could be infectious such as wound infection or non-infectious such as pulmonary embolism.
Groin swellings/Problem Based Learning/ clinical case scenario triggersSelvaraj Balasubramani
Problem Based Learning/ Groin Swellings/ Clinical case scenario triggers
To know the answers watch the following video in YouTube
https://www.youtube.com/watch?v=DU9QrGOrewE&t=2756s
In this PPT I am discussing about post-operative fever on POD#3. This is commonly due to catheter associated urinary tract infection- CA-UTI. The cause is keeping urinary catheter too long. I am discussing about how to diagnose this problem and how to manage it. you can watch all my teaching videocasts in the following links:
surgicaleducator.blogspot.com
This latest edition is every surgeon's must have to make confident surgery decisions. Featuring new chapters on Liver Transplantation, the aorta, The Difficult Abdominal Wall etc.
Check out the sample chapter 13. For purchase, please visit www.asia.elsevierhealth.com
Groin swellings/Problem Based Learning/ clinical case scenario triggersSelvaraj Balasubramani
Problem Based Learning/ Groin Swellings/ Clinical case scenario triggers
To know the answers watch the following video in YouTube
https://www.youtube.com/watch?v=DU9QrGOrewE&t=2756s
In this PPT I am discussing about post-operative fever on POD#3. This is commonly due to catheter associated urinary tract infection- CA-UTI. The cause is keeping urinary catheter too long. I am discussing about how to diagnose this problem and how to manage it. you can watch all my teaching videocasts in the following links:
surgicaleducator.blogspot.com
This latest edition is every surgeon's must have to make confident surgery decisions. Featuring new chapters on Liver Transplantation, the aorta, The Difficult Abdominal Wall etc.
Check out the sample chapter 13. For purchase, please visit www.asia.elsevierhealth.com
case presentation on Intestinal perforation NEHA MALIK
Intestinal perforation, defined as a loss of continuity of the bowel wall, is a potentially devastating complication that may result from a variety of disease processes. Common causes of perforation include trauma, instrumentation, inflammation, infection, malignancy, ischemia, and obstruction.
YOUTUBE CHANNEL LINK:- https://www.youtube.com/results?search_query=medic+o+mania
Incidence of ectopic pregnancy is rising while maternal mortality from it is falling.
ALWAYS suspect ectopic pregnancy in a woman of a child-bearing age c/o pain and/or p.v. bleeding
Meconium-stained amniotic fluid is common complication, seen in 1 out of every 5 pregnancies.Golden rule for management of MSAF is Foetal Heart Monitoring
case presentation on Intestinal perforation NEHA MALIK
Intestinal perforation, defined as a loss of continuity of the bowel wall, is a potentially devastating complication that may result from a variety of disease processes. Common causes of perforation include trauma, instrumentation, inflammation, infection, malignancy, ischemia, and obstruction.
YOUTUBE CHANNEL LINK:- https://www.youtube.com/results?search_query=medic+o+mania
Incidence of ectopic pregnancy is rising while maternal mortality from it is falling.
ALWAYS suspect ectopic pregnancy in a woman of a child-bearing age c/o pain and/or p.v. bleeding
Meconium-stained amniotic fluid is common complication, seen in 1 out of every 5 pregnancies.Golden rule for management of MSAF is Foetal Heart Monitoring
This simplified lecture will present to you the basic concept of intracanal medicaments, their indication, classification, and their appropriate selection.
Presented to you by Iraqi Dental Academy.
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Fever post operative (gynaecological)
1. Prof. M.C.Bansal.
Founder Principal &controller; Jhalawar Medical
College Jhalawar.
Ex. Principal & Controller; Mahatma Gandhi
Medical College & Hospital; Sitapura, Jaipur
2. Definition Fever is the rise of normal core temperature of an individual that
exceeds the normal diurnal variation and is accompanied by an increased
hypothalamic setup.
DiurnalVariation in 18-40 years of age—
MeanTemperature : 36.8+/- 0.4 C (98.2+/- 0.7 F ). ;being low at 6 AM –36.2 c or98.0 F
and highest at 4-6pm in the range of 37.7 c or 98.9 F.
Temperature > 38C(100.4 F )recorded at two occasions at the interval of 4hrs apart ,
excluding 1st 24 hrs after surgery or any one temperature recording more than 38.6 c
( 101.5 F ) is taken as post operative fever.
Incidence varies widely from 14-91 % .
THIS MAY BE INFECTIOUS / NONINFECTIOUS.
80-90 % patients developing temperature with in 24hrs after operation are not infected
, but patients who develop fever on /5th post operative day(80-90 % ) usually have
commonly identifiable infection .
Infection is definite if it develops after 2days of surgery.
3. Shivering;
Chills– may be alternate to feeling of hot;
General Malaise;
Somnolence;
Anorexia;
Arthralgia , myalgia, skin sensitivity to touch ;
Absence / presence of sweating;
Skin rash;
Increased pulse rate / BP.
4. Time related causes described here are only guidelines
and do not serve as rule. On many times there is temporal
overlap in the causes described –5Ws
POD 1-2 Wind (respiratory ) atelectasis develop within
24-48 hrs . Aspiration pneumonia, ventilator associate
pneumonia .
POD3-5Water—UTI, specially in catheterized patient.
POD5-6W(veins) , wings , walking –DVT , Iv cannula site
plebitis , IM, injection abscess.
POD5-7 wound– check for wound infection ,drainage ,
alternate sutures removal , swab culture and diagnose
serious problem such as necrotizing fascitis and peritonitis
due to intestinal leak ( internal wound).
POD 7+ Wonder if ? Drug induced—drug reaction ,
drugs used intra / post operative / transfused blood or
blood products , anti inflammatory agents etc.
6. Malignant Hyperthermia rare
dominantly transient
genetic disorder triggered by administration of succinyl
chloride
occurs with in ½ an hour of its administration , but may
persist for < 10 hours.
BP unstable , rise in heart rate , fever may shoot up to 41-
42 C .
Muscle rigidity , acidosis, hypoxia cardiac arrhythmia
develops .
Treatment is to stop all anesthetic drugs , hyper
ventilation, O2.
Initiate cooling , and diuresis to prevent precipitation of
myoglobin . Inject dantrolene sodium and procainamide.
7. Adrenal Insufficiency-Typically occurs in patient
who are taking corticosteroids for a long duration ;
owing to suppression of endogenous steroids
(hypothalmo- pituitary –adrenal axis ). Fever ,
refractory fall in BP may develop . Steroid
supplementation in time will resolve the problem.
Pulmonary embolism usually presents as
hemodynamic sudden post operative hemodynamic
instability and collapse . Fever, although uncommon ,
may be present.
AlcoholWithdrawal frequently presents with fever ,
prompt recognition and treatment prevents excessive
morbidity and mortality.
8. Myo necrosis –
common due to wound infection
Clostridium species or group A Strepto –cocci.
It is a surgical emergency
patient presents with shock, tachycardia, fever and septicemia
with in 24 hours after operation.
Di9agnosis is easy if dressing is opened and wound is examined .
Thin brownish copious malodorous discharge is present .Take
swab for culture and sensitivity.
Skin may be discolored , subcutaneous crepitations , bullae
formation .Patient has severe pain, restlessness and local
tenderness. If not treated immediately patient may have vascular
collapse, acute renal failure , haemoglobinuria and jaundice.
Wide excision of all infected and necrosed tissue , high dose of C.
penicillin 20 lacs 6hrly after AST / tetracyclines is mandatory.
D/D – metastastic Myonecrosis from adeno carcinoma of bowel
9. Necrotizing Fascitis
occurs due to wound infection by poly microbes–
haemolytic strepto cocci, staphylococcis anaerobes or
mixed bacteria.
Necrosis of superficial fascia results ; underlying
muscle are spared .Toxicity is more severe thanWBC
counts / fever / hypothermia , hypotension
,tachycardia and lethargy.
Locally the wound is dusky with subcutaneous edema
, induration, crepitations , hyperesthesia and bullae
formation in skin .
Haemoconcentration ,hypokalemia , hemolysis,
hyperbilrubinaemia develop at faster rate.
Hepatic, renal pulmonary insufficincy soon develop
and patient is in state of septic shock.
10. Aggressive treatment started as in cases of major
degree burns.
Predisposing factors include --- diabetes , obesity,
trauma , alcoholism , immunosuppressive state,
hypertension , peripheral vascular disease , IV drug
abuse and addiction .
A wide excision and debridement / re debridement is
done .
Iv fluid therapy and nutrition with correction of
electrolyte imbalance and broad spectrum antibiotics
are started ; to be changed as soon the c/s reports are
available.
11. Intestinal Leak It occurs early / late from devitalized
/ crushed intestine during dissection from pelvic
tumors / leaking anastomosis site.
Diagnosed by suspicion / flat plate abdomen in
standing posture for gas under diaphragm.
Manage by -- exploratory laparotomy , repair of the
damaged gut , peritoneal toileting and drainage ,
blood transfusion , antibiotics , resuscitation with fluid
,electrolytes minerals , vitamin supplementation .
Ketoacidocis is prevented by ensuring adequate total
parenteral nutritional therapy; till oral feeding is
suspended .
12. A care full review of history , investigations ,pre / intra
, post operative sequence of events .
Through general physical, systemic and operative site
examination , Consultation with physician / general
surgeon / necessary investigations are the key points
in prompt diagnosis of post operative fever.
An early , timely and appropriate diagnosis ,
immediate treatment helps in minimizing the
mortality and morbidity
The presence of non infectious cause of fever does not
exclude the possibility of infective reason as both
may co –exist.
13. Fever associate with diarrhoea and central abdominal
pain---- Enterocolitis due to c Clostridium difficile.
Calf pain & tenderness--- DVT .
Cough with sputum , breathlessness ---Pulmonary
infection .
Urinary frequency , dysurea, haematurtia , urgency supra
pubic and loin pain ----UTI / Pyelonephrytis.
Site of pain ---helps in localizing the infection ---wound , IV
cannula , catheter site . Intense pain at wound ,
restlessness with fever may be due to clostridium
myonecrosis.
Fever with delirium ---- acute alcohol withdrawal .
Rigors and chills ---atelectasis , malaria / pyelonephritis.
Headache , projectile vomits, stiff neck----Meningitis.
Pain at IM injection site-----injection abscess
14. Previous H/O pyrexial illness ---Malaria,TB, Sinusitis ,UTI
,pulmonary disease( empyema, plueral effusion bronciectasis ).
Local infection--- vaginal vaginosis, cervicitis , infected fibroid /
malignant legion/ decubitous ulcer in case of prolapse , skin
infection at the site of skin incision etc
Family or Personal H/O malignant hype pyrexia , thyroid disorder ,
IV drug abuse , alcohol / tobacco intake , obesity , Pre operative
transfusion of blood , fluids . Drugs and drug reaction.
Patients who are more susceptible ---- obese , diabetic , Immuno
compromised , taking chemo / radiotherapy , Corticosteroids ,
debilitating disease, malnutrition , renal / liver insufficency ,
extremes of age ( old aged ) and BP, cardiac valular disease.
15. Date of surgery ---exact Post operative day and onset
of fever .
Its type and duration ,
Use of Implants—mesh
Type and duration of preoperative antibiotics given .
Pattern of onset of symptoms on which Post
operative day . Existing symptoms prior to surgery ,
investigations / any treatment given and its response .
Any complication during operation / anesthesia.
H/O prolonged ventilation .
Left over packing , swabs or instruments / poor
debridement / excision of infected , nacrosed tissue /
un recognized / over looked injury to gut.
16. Monitor vital parameters .
If tachycardia is out of proportion to rise in
temperature is an ominous sign as in severe sepsis ,
associated with hypotension and oliguria.
Tachypnoea --- pulmonary cause .
Pattern , trend and its flctuation should be noted.
Detailed examination of wound– color of skin ( dusky ,
red, blue/black , indurations , discharge(amount,
color , odor , frothing ) , tenderness, necrosis of edges,
bulla , crepitations.
if any ,silent dehiscence of wound , presence of
cellulitis , fascitis, abscess, haematoma, gas gangrene
hyperaesthesia, spreading erythematous streaks.
17. In early stage of wound infection, there is
swelling ,warmth ,redness peri wound edema
and increasing tenderness .
Later there are more signs of stephylococcal
infection ---maximum erythema and fluctuation
; while with enteric organisms tenderness is
more and erythema is minimal.
Other signs of infection like fever , malaise .
Leucocytosis ,tachycardia/ chills may develop.
Lymph node draining the infected are may also
be involved---to be examined.
18.
19.
20.
21.
22.
23. All intravenous puncture sites with/ without cannulae along with
all drain sites ---to be seen for any evidence of infection as
thoroughly as wound site examination.
Nose , throat , ear, chest for infection ---sinusitis , chronic SOM,
atelectasis/ consolidation/ collapse of lung / pleural effusion /
empyema , Pulmonary embolism .
Abdominal Examination---hepato splenomegaly and tenderness,
abdominal distension , tenderness (localized or general ),rebound
tenderness , free fluid , characters of intestinal sounds , evidence
of peritonitis , intraperitoneal abscess, foreign body , peri nephric
abscess, subdiaphragmatic abscess , pelvic abscess(PR / PV if
needed needling).
27. Bacteriological assessment---
Blood culture , urine culture , wound swab
culture
sputum/ aspirated pleural fluid / peritoneal fluid
. CSF , if LP done
Needle aspirate from indurated area/ sp[reading
cellulitis surrounding wound / enlarged lymph
node , culture from cannula and catheter on
removal.
Stool culture. It should be for identification of
Pathogen and their sensitivity to drugs .
28. Chest X ray --- PA view --- Pneumonia, etelactasis, pleural
effusion , pleural thickening , metastasis , Lung collapse.
Consolidation , tuberculosis. Chronic bronchitis , cardiomegaly
, pulmonary embolism. Pericardial effusion . Mediastinal mass
etc.
Flat plate Abdomen --- multiple fluid levels and distended
intestinal loops incases of peritonitis., air under diaphragm in
cases of intestinal perforation. displacement of gas filled
intestinal loops by foreign body, pelvic abscess/ free fluid in
peritoneal cavity.
29. USG Whole abdomen and pelvis ----amoebic
liver abscess, spleen and liver enlargement, renal
and peri nephric pathology , pelvic abscess,
hematoma, forgotten lepard /instrument .
Doppler can help in identifying thrombosis.
CAT & MRI can identify abscess , foreign body ,
hematoma and other lesions .
ECG and Echocardiography ---- myocardial
infarction , pulmonary embolism , intra cardiac
thrombus , valvular disease .
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43. Infection / pus collection may be located My be ---
- endogenous, exogenous ( nurse / doctor ,
instruments , visitors , aseptica conditions of Hospital )
1. Intracranial --thorough History , CNs examination ,
LP , Brain scan---Cat / MRI with dye or without dye.
2. Above Oral Diaphragm –sinusitis, pharyngitis ,Ch.
SOM , Parotid abscess ,Tonsillitis ---ENT checkup ,
throat swab culture .
3. AboveThoraces -abdominal Diaphragm—cardio –
respiratory system—History taking , Chest
examination , X ray chest , sputum examination,
culture , ECG and echocardiogram.
44. 4. Above Pelvic diaphragm --- Symptoms and signs on
abdominal ,pelvic , PR , p v examination .Wound
examination , flat plate X Ray in standing position ,
CBC , wound swab culture, USG,TVS , Urine
examination and culture , Blood culture , catheter /
drain / canola site examination , and culture .
5. In between Pelvic and perineal diaphragm ----
local symptoms of deep seated pain in pelvis and
perineum ---local examination --- pelvic and Perineal
USG.
6. other sites--- gluteal region , Calf muscles for DVT ,
Epidural / spinal anesthesia site .
45.
46.
47. It is directed at the cause .
General Measures---Replacement of fluid loss ,
maintain input out put , electrolytes, nutrition , avoid
development of acidosis, control fever below 1ooF by
antipyretics( paracetamol / N-SAIDs and Aspirin ) ,
cold sponging.
In patient to have an infection , examination to
localize the site and source of infection , culture for
identification of offending pathogens / their
sensitivity to antibiotics --- and appropriate therapy in
optimal doses is must.
Surgical intervention may be required in the form of
wound debridement , excision of infected wound or
diseased organ to eliminate the constant source of
infection and drainage of pus collected at any site .
48.
49.
50.
51. Exploratory Laparotomy when intra peritoneal lesion
is suspected .
Septic pelvicThrombophlebitis may develop 2-4 days
postoperatively. Clinical signs may be unreliable ; can
best be confirmed by Doppler USG / venography .
Immediate heparinization and broad spectrum
antibiotic therapy should be started.
Patient with septic shock need fluid resuscitation ,
inotopes , vasoactive drugs are needed to address
impending myocardial depression . Mechanical
Ventilation with high saturated oxygenation in ICU
will be needed.
52. Careful temperature recording and pulse
monitoring will help in early detection of the
fever.
Thorough review of each individual- right from
the history, pre-op, intra-op, post-op clinical
examination and relevant investigations will
help to clinch the diagnosis.
Appropriate conservative/ operative
management should be started as early as
possible and if needed, second opinion from
fellow colleagues- physician, surgeon and
anesthetist, microbiologist should be sought.