Master the board step 3

Master the Boards: USMLE Step 3
Postpartum Fever
PP Day Diagnosis Risk Factors Clinical Findings Management
0 Atelectasis General anesthesia
with incisional
pain
Cigarette smoking
1 UTI Multiple
catheterizations
and vaginal
exams
2–3 Endometritis C-section,
prolonged
rupture of
membranes,
multiple vaginal
exams
4–5 Wound infection Emergency
c-section after
PROM
5–6 Septic
thrombophlebitis
Prolonged labor
7–21 Infectious mastitis Nipple trauma and
cracking
Mild fever with mild rales
Patient is unable to take
deep breaths
High fever, CVA
tenderness, (+) urinalysis,
(+) urine culture
Moderate-to-high fever,
uterine tenderness, (–)
peritoneal signs
Persistent spiking fever
despite antibiotics
Wound erythema,
fluctuance, or drainage
Persistent wide fever
swings despite broadspectrum
antibiotics
Unilateral breast
tenderness, erythema,
and edema
Incentive spirometry and
ambulation
Chest x-rays are
unnecessary
Single-agent intravenous
antibiotics
Multiple-agent IV
antibiotics (e.g.,
gentamycin and
clindamycin)
IV antibiotics
Wet-to-dry wound
packing
Closure by secondary
intention
IV heparin for 7–10 days
PO nafcillin
Breastfeeding should be
continued
Contraindications to Breastfeeding
··
Infections in the mother:
--
HIV
--
Active tuberculosis
--
HTLV-1
--
Herpes simplex if there is a lesion on the breast
··
Use of drugs/medications
··
Drugs of abuse (except cigarettes, alcohol)
··
Cytotoxic medications (e.g., methotrexate, cyclosporine)
··
Condition of the infant
--
Galactosemia
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