18. Post Op Complications - LL Flashcards
Who is at a higher risk of developing a HEMATOMA after surgery?
Taking ASA or anticoagulants, coagulopathies, BP >150/100
Should you re-open a wound that has developed a hematoma?
Sure as shit. Re-open, ligate, re-close.
What are 2 common locations that seromas develop frequently?
post-mastectomy, in the groin
What’s the initial management to both empty the seroma and to prevent it from filling again?
Needle aspirate then apply compression dressings
What is the FIRST SIGN of a dehiscence?
Discharge of serosanginous fluid. Patient may describe a “popping sensation” when coughing or retching.
What is the most common time frame for a dehiscence?
5-8 days post-op
What systemic factors can put you at higher risk of dehiscence?
DM, steroid use, cancer, sepsis, jaundice, obesity, etc.
What happens if you eviscerate out your laparotomy wound?
Cover your junk in moist towels (not, moist toilettes), then proceed to hospital ASAP for surgery.
Do you re-close a dehiscence before or after you treat a present infection?
AFTER DUH!
Most common cause of atelectasis post-op?
Closure of the bronchioles
Atelectasis is most common in what time frame?
FIRST 48 HOURS! Accounts for 90% of febrile episodes during that time.
Presentation and physical exam of a patient presenting with atelectasis?
FEVER, tachypnea, tachycardia
Exam: trachea deviated towards affected side, elevated diagram, scattered rales, decreased breath sounds (often normal too)
How to prevent atelectasis post-op?
frequent mobilization and changes in position, encourage to cough
How do we treat a keloid that has formed?
Triamcinolone injections
What type of orthopedic surgeries result in a lot of FAT EMBOLI?
fractures of long bones or joint replacements
What is fat embolism syndrome?
neurologic dysfunction, respiratory insufficiency, and petechiae of the axillae, chest, and proximal arms.
What heart chamber do air emboli lodge in?
Right Atrium - therefore presents with JVD!
How do you prevent air emboli?
Place patient in the Trendelenburg position when a central venous line is inserted
If XR of abdomen shows air-fluid levels in loops of small bowel, is this an urgent problem?
YES! Death rate is 15% with bowel obstruction
When should prophylactic bladder catheterization be preformed on a patient to prevent urinary retention?
When operation is likely to last >3 hours or when large volumes of IV fluids are anticipated.
What is the most common cause of FEVER after the 3rd post-op day?
IV Phlebitis! Symptomatic triad of induration, edema, and tenderness
What type of IV catheters are least reactive if they are to be placed for a long time?
Silastic catheters
What is the most common cause of fever during these time frames:
48 hrs:
>5 days:
>1 wk:
< 48 hrs = atelectasis
>48 hrs = phlebitis, pneumonia, UTI
>5 days = infection
>1 wk (is rare)= allergy to drugs, transfusion-rxn, intraabdominal abscess
Respiratory failure < 3 days post-op is usually? Respiratory failure > 3 days post-op is usually?
< 3 days: Atelectasis (have we driven this home yet?), pneumonia, or aspiration
>3 days: PE!
