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Difficulty: EasyPreoperative and Postoperative Care

A surgical clerkship director is teaching medical students about the evaluation of postoperative fever. To help students prioritize their differential diagnoses, she asks them to recall the classic timeline for various complications. Arrange the following common etiologies of postoperative fever in typical chronological order, from earliest expected onset to latest expected onset.

  1. 1Atelectasis
  2. 2Catheter-associated urinary tract infection
  3. 3Deep surgical site infection
  4. 4Deep vein thrombosis

Answer

The classic chronological sequence for the onset of postoperative fever is Atelectasis, followed by Catheter-associated urinary tract infection, Deep surgical site infection, and finally Deep vein thrombosis.
The timeline of postoperative fever is classically taught using the 'W's mnemonic. Atelectasis ('Wind') occurs first (days 1-2), followed by urinary tract infections ('Water') from catheter use (days 3-5), surgical site infections ('Wound') as bacteria incubate and form abscesses (days 5-7), and deep vein thrombosis ('Walking') from prolonged immobility (days 7-10).

Step-by-Step Solution

1
Determine the onset time for atelectasis ('Wind').
Atelectasis classically presents on postoperative days 1 to 2.
Early postoperative fever is most commonly associated with pulmonary issues like atelectasis or an expected physiologic inflammatory response to surgical tissue injury.
2
Determine the onset time for a urinary tract infection ('Water').
Urinary tract infections typically manifest on postoperative days 3 to 5.
Foley catheter use and postoperative urinary retention create an environment for bacterial colonization that takes a few days to cause a systemic fever.
3
Determine the onset time for a surgical site infection ('Wound').
Surgical site infections most commonly appear on postoperative days 5 to 7.
It takes several days for contaminating bacteria to incubate and proliferate sufficiently to form an abscess or cause significant cellulitis.
4
Determine the onset time for deep vein thrombosis ('Walking').
Deep vein thrombosis typically presents on postoperative days 7 to 10.
Prolonged postoperative immobility leads to venous stasis, allowing time for significant thrombus formation and potential pulmonary embolism.

Key Concept

The classic mnemonic 'Wind, Water, Wound, Walking' is used to recall the chronological timeline of common postoperative fever etiologies.
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Topics

Preoperative and Postoperative Care

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