3: Post-Op Complications Flashcards
define post-op fever
a core body temperature >38 degrees for 2 consecutive days or >39 degrees for 1 day
what are the most common causes of post-op fever
- 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
why are patients prone to chest infection post-op
anyone who has had a GA will experience basal atelectasis –> air stasis
what is SIRS
an inflammatory state that the body takes on in response to infectious or non-infectious insult
what are criteria for SIRS
need 2/4 of these criteria
- then suspected source of sepsis to confirm sepsis
what is severe sepsis
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
define septic shock
severe sepsis and persistent hypotensions despite 30mL/kg crystalloid (fluid resuscitation)
- lactate >4mmol/L
what beside tests are of use in approaching post-op fever
- 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
what blood tests are of use in approaching post-op fever
- 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
what imaging is of use in approaching post-op fever pt
- CXR
- abdo USS
- CT
what is involved in the management of patients with post-op fever
- O2?
- fluid balance: IV fluids, urinary catheter
- drugs: analgesia, anti-emetics, antibiotics
- VTE prophylaxis
- escalation
what are common respiratory post-op complications
atelectasis
pneumonia
what are common cardiovascular post-op complications
MI
what are common post-op wound complications
- infection
- dehiscence
what are common thromboembolic post-op complications
DVT
PE
what are common GI post-op complications
- ileus
- bowel obstruction
what are common urinary post-op complications
- urinary retention
- UTI
what factors can affect the likelihood of developing post-op complications
- patient: age, comorbidities, smoking
- surgical: type & duration of surgery
- anaesthetic: GA, post op pain management
- environmental: post op care, hospital environment
how does atelectasis present + examination findings
- tachypnoea
- SOB
- low sats <93-94%
- unable to take deep breath
- decreased chest expansion and air entry on auscultation
CXR findings of atelectasis
- blunting of costophrenic angles
- loss of lung borders
what investigations are carried out into atelectasis
- baseline bloods
- CXR
what is the treatment of atelectasis
- chest physio
- mobilisation
- analgesia
- nebs
- supplemental o2
- bronchoscopy to remove obstruction e.g. mucous plug
- mechanical ventilation
what is involved in the prevention of pneumonia
- smoking cessation
- pre-op assessment
- resp assessment
- early mobilisation
- adequate analgesia
how might a wound infection present
- erythema
- warm
- tender on exam
- oozing pus
- foul smelling
what is the treatment plan of a wound infection
- 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
what is wound dehiscence and how might it present
partial or complete opening of the wound
- visible opening
- poor healing
- erythema
- seepage of fluid
- broken sutures
- pulling or ripping
what is involved in the treatment of wound dehiscence
- wound care
- analgesia
- abx
- negative pressure wound therapy
- surgical debridement
what is a seroma and how is it treated
- fluid collection wound, fluctuant on exam
- drainage due to risk of infection
what is a haematoma
- treatment
- risks
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)
what is the management of DVT
- analgesia
- USS leg
- prophylactic LMWH
- longterm DOACs
what is the management of PE
- A-E assessment
- O2
- D-Dimer
- CTPA
- LMWH/DOACS
