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ANAESTHETICS & PERI-OPERATIVE MEDICINE > 3: Post-Op Complications > Flashcards

3: Post-Op Complications Flashcards

1
Q

define post-op fever

A

a core body temperature >38 degrees for 2 consecutive days or >39 degrees for 1 day

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2
Q

what are the most common causes of post-op fever

A
  • wind: chest infection, day 2
  • water: UTI, day 3-5, catheter
  • walking: VTE, day 5-7, stress response, immobility
  • wound: surgical site infection, day 10
  • wonder drugs: iatrogenic, IV cannulation, transfusion reaction
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3
Q

why are patients prone to chest infection post-op

A

anyone who has had a GA will experience basal atelectasis –> air stasis

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4
Q

what is SIRS

A

an inflammatory state that the body takes on in response to infectious or non-infectious insult

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5
Q

what are criteria for SIRS

A

need 2/4 of these criteria
- then suspected source of sepsis to confirm sepsis

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6
Q

what is severe sepsis

A

SIRS criteria + source of infection –> organ dysfunction
- sBP < 90MMHg or MAP<65mmHg (in hypertensive pt look for a drop in BP >40mmHg)
- lactate >2
- urine output <0.5ml/kg/hr for 2 consecutive hours
- drop in GCS or AMTS score

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7
Q

define septic shock

A

severe sepsis and persistent hypotensions despite 30mL/kg crystalloid (fluid resuscitation)
- lactate >4mmol/L

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8
Q

what beside tests are of use in approaching post-op fever

A
  • VBG if pt becomes hypotensive to monitor plasma lactate which will be raised in end organ damage or tissue hypoperfusion
  • HR: monitor for tachycardia which is part of SIRS, new onset AF (ECG)
  • spO2: guide o2 therapy, confirm chest infection
  • capillary blood glucose
  • urine dipstick: UTI
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9
Q

what blood tests are of use in approaching post-op fever

A
  • ABG/VBG
  • FBC: WCC, Hb (anemic secondary to blood loss during surgery)
  • CRP: look for trend
  • platelet count & clotting profile: assess haemostasis
  • U&Es: pre-renal AKI
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10
Q

what imaging is of use in approaching post-op fever pt

A
  • CXR
  • abdo USS
  • CT
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11
Q

what is involved in the management of patients with post-op fever

A
  • O2?
  • fluid balance: IV fluids, urinary catheter
  • drugs: analgesia, anti-emetics, antibiotics
  • VTE prophylaxis
  • escalation
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12
Q

what are common respiratory post-op complications

A

atelectasis
pneumonia

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13
Q

what are common cardiovascular post-op complications

A

MI

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14
Q

what are common post-op wound complications

A
  • infection
  • dehiscence
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14
Q
A
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15
Q

what are common thromboembolic post-op complications

A

DVT
PE

16
Q

what are common GI post-op complications

A
  • ileus
  • bowel obstruction
17
Q

what are common urinary post-op complications

A
  • urinary retention
  • UTI
18
Q
A
19
Q

what factors can affect the likelihood of developing post-op complications

A
  • patient: age, comorbidities, smoking
  • surgical: type & duration of surgery
  • anaesthetic: GA, post op pain management
  • environmental: post op care, hospital environment
20
Q

how does atelectasis present + examination findings

A
  • tachypnoea
  • SOB
  • low sats <93-94%
  • unable to take deep breath
  • decreased chest expansion and air entry on auscultation
21
Q

CXR findings of atelectasis

A
  • blunting of costophrenic angles
  • loss of lung borders
22
Q

what investigations are carried out into atelectasis

A
  • baseline bloods
  • CXR
23
Q

what is the treatment of atelectasis

A
  • chest physio
  • mobilisation
  • analgesia
  • nebs
  • supplemental o2
  • bronchoscopy to remove obstruction e.g. mucous plug
  • mechanical ventilation
23
Q

what is involved in the prevention of pneumonia

A
  • smoking cessation
  • pre-op assessment
  • resp assessment
  • early mobilisation
  • adequate analgesia
24
Q

how might a wound infection present

A
  • erythema
  • warm
  • tender on exam
  • oozing pus
  • foul smelling
25
Q

what is the treatment plan of a wound infection

A
  • open wound to let pus drain
  • wound swab
  • empirical abx then check sensitivites
  • wound wash and daily dressings
  • hyperbaric o2
  • special dressing e.g. povidone iodine coated or Aquacell
26
Q

what is wound dehiscence and how might it present

A

partial or complete opening of the wound
- visible opening
- poor healing
- erythema
- seepage of fluid
- broken sutures
- pulling or ripping

27
Q

what is involved in the treatment of wound dehiscence

A
  • wound care
  • analgesia
  • abx
  • negative pressure wound therapy
  • surgical debridement
28
Q

what is a seroma and how is it treated

A
  • fluid collection wound, fluctuant on exam
  • drainage due to risk of infection
29
Q

what is a haematoma
- treatment
- risks

A

blood collected in wound or deep surgical site
- ✅ drainage
- ⚠️ haemodynamic unstability, resp compromise in thyroidectomy due to compression of trachea (always escalate in pt in tachypneoic + swelling, redness)

30
Q

what is the management of DVT

A
  • analgesia
  • USS leg
  • prophylactic LMWH
  • longterm DOACs
31
Q

what is the management of PE

A
  • A-E assessment
  • O2
  • D-Dimer
  • CTPA
  • LMWH/DOACS

ANAESTHETICS & PERI-OPERATIVE MEDICINE (5 decks)

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