18. Post Op Complications - LL

Question 1

Who is at a higher risk of developing a HEMATOMA after surgery?

Answer 1

Taking ASA or anticoagulants, coagulopathies, BP >150/100

Question 2

Should you re-open a wound that has developed a hematoma?

Answer 2

Sure as shit. Re-open, ligate, re-close.

Question 3

What are 2 common locations that seromas develop frequently?

Answer 3

post-mastectomy, in the groin

Question 4

What’s the initial management to both empty the seroma and to prevent it from filling again?

Answer 4

Needle aspirate then apply compression dressings

Question 5

What is the FIRST SIGN of a dehiscence?

Answer 5

Discharge of serosanginous fluid. Patient may describe a “popping sensation” when coughing or retching.

Question 6

What is the most common time frame for a dehiscence?

Answer 6

5-8 days post-op

Question 7

What systemic factors can put you at higher risk of dehiscence?

Answer 7

DM, steroid use, cancer, sepsis, jaundice, obesity, etc.

Question 8

What happens if you eviscerate out your laparotomy wound?

Answer 8

Cover your junk in moist towels (not, moist toilettes), then proceed to hospital ASAP for surgery.

Question 9

Do you re-close a dehiscence before or after you treat a present infection?

Answer 9

AFTER DUH!

Question 10

Most common cause of atelectasis post-op?

Answer 10

Closure of the bronchioles

Question 11

Atelectasis is most common in what time frame?

Answer 11

FIRST 48 HOURS! Accounts for 90% of febrile episodes during that time.

Question 12

Presentation and physical exam of a patient presenting with atelectasis?

Answer 12

FEVER, tachypnea, tachycardia
Exam: trachea deviated towards affected side, elevated diagram, scattered rales, decreased breath sounds (often normal too)

Question 13

How to prevent atelectasis post-op?

Answer 13

frequent mobilization and changes in position, encourage to cough

Question 14

How do we treat a keloid that has formed?

Answer 14

Triamcinolone injections

Question 15

What type of orthopedic surgeries result in a lot of FAT EMBOLI?

Answer 15

fractures of long bones or joint replacements

Question 16

What is fat embolism syndrome?

Answer 16

neurologic dysfunction, respiratory insufficiency, and petechiae of the axillae, chest, and proximal arms.

Question 17

What heart chamber do air emboli lodge in?

Answer 17

Right Atrium - therefore presents with JVD!

Question 18

How do you prevent air emboli?

Answer 18

Place patient in the Trendelenburg position when a central venous line is inserted

Question 19

If XR of abdomen shows air-fluid levels in loops of small bowel, is this an urgent problem?

Answer 19

YES! Death rate is 15% with bowel obstruction

Question 20

When should prophylactic bladder catheterization be preformed on a patient to prevent urinary retention?

Answer 20

When operation is likely to last >3 hours or when large volumes of IV fluids are anticipated.

Question 21

What is the most common cause of FEVER after the 3rd post-op day?

Answer 21

IV Phlebitis! Symptomatic triad of induration, edema, and tenderness

Question 22

What type of IV catheters are least reactive if they are to be placed for a long time?

Answer 22

Silastic catheters

Question 23

What is the most common cause of fever during these time frames:
48 hrs:
>5 days:
>1 wk:

Answer 23

< 48 hrs = atelectasis
>48 hrs = phlebitis, pneumonia, UTI
>5 days = infection
>1 wk (is rare)= allergy to drugs, transfusion-rxn, intraabdominal abscess

Question 24

Respiratory failure < 3 days post-op is usually? Respiratory failure > 3 days post-op is usually?

Answer 24

< 3 days: Atelectasis (have we driven this home yet?), pneumonia, or aspiration
>3 days: PE!