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Clinical > 7 Surgery - Management of post-op issues > Flashcards

7 Surgery - Management of post-op issues Flashcards

1
Q

Patients factors increasing VTE risk (5)

A 
Age
Obesity
Varicose Veins
History of DVT/PE
Clotting disorders
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2
Q

Surgical factors increasing VTE risk (3)

A

Immobility – bed rest or reduced mobility
Dehydration
Trauma or surgery - increased risk with:
(↑ duration, Type of surgery ↑ risk with pelvis or abdo surgery for cancer, Major limb amputation, Major trauma or orthopaedic surgery)

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3
Q

Medical factors associated with increase VTE risk

6

A 
Malignancy
Oestrogen therapy
Pregnancy or post partum
Co-morbidity
Severe infection
Lower limb paralysis
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4
Q

All patients must have VTE assessment with ……………….. of admission.

Reassed every ………………..

A

24H

72H

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5
Q

Non-pharma ways to reduce risk of VTE (3)

A

Hydrate
Mobilise ASAP
Stop meds that increase risk if possible

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6
Q

3 mechanical propylaxis of VTE methods

A

Compression stockings
Intermittent pneumatic compression
Foot impulse devices

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7
Q

If low risk of VTE what should be done for prophylaxis?

A

Early mobilisation and copression stockings (if not contrqaindicated)

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8
Q

If high risk consider

A

LMWH/NOAC

intermittent pneumatic compression during suregery

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9
Q

Assess bleed vs VTE risk with

A 
Active bleeding
Recent surgery
Recent stroke
Spinal intervention
Concurrent use of anticoagulants
Uncontrolled systolic hypertension
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10
Q

When do you stop VTE prophylaxis?

A

Continue until mobilized

Extend regime required for some procedures such as cancer/ #NOF/ lower limb cast

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11
Q

NOACs licenced for what surgery VTE prophylaxis?

A

Total hip/total knee replacement

Caution errors of duplication

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12
Q

NOACs licenced for what surgery VTE prophylaxis?

A

Total hip/total knee replacement

Caution errors of duplication

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13
Q

If pain is poorly managed…

A 
↓ Recovery & ↑ length of stay
↓ Mobility & ↑ VTE risk
↓ wound healing
↑ BP & Pulse
↑ Anxiety & disturb sleep
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14
Q

e.g. of procedure specific pain relief

A

gabapentin/oxycodone with total knee replacement

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15
Q

PONV affects ….% of pt

A

30

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16
Q

What is the cause of PONV

6

A
  • Anaesthetic agents
    • Opioid analgesia
    • Bowel surgery
    • Antibiotics
    • U&E disturbances
    • Bowel obstruction
17
Q

Problems with poorly managed PONV (4)

A
  1. ↑ length of stay
  2. Cause dehydration & electrolyte disturbance
  3. Disrupt wounds
  4. Reduce medicines absorption
18
Q

Apfel scoring for PONV

A 
1 point for:
female
History of motion sickness/PONV
Non-smoker
Opiate use
0 = 10% 1 = 20% 2 = 40%
3 = 60% 4 = 80%
19
Q

What meds are usually used for PONVL (4)

A

ondansetron, cyclizine, dexamethasone or prochlorperazine
- number prescribe depends on risk factors

metoclopriamide is not v effective

20
Q

why is their high bleed risk for spinal injurys

A

subdural epidural bleeds are catastrophic

21
Q

How much does one antiemetic reduce PONV risk?

A

25%

- use this to work out how many to prescribe

22
Q

When to administer anti emetics?

A

20-30mins before planned end of surgery.

Except dexamethasone which is given at induction

23
Q

Vomiting centre has what receptors? What does each antiemetic target?

A 
Cyclizine (antihistamine)‏
Ondansetron (serotonin antagonist)‏
Dopamine Antagonists:
Metoclopramide Domperidone
Prochlorperazine
24
Q

~Infection risk depends on: (4)

A
  • degree of contamination during surgery
  • patient factors
  • operation length
  • surgeon skill
25
Q

Types of procedures with infection risk

A

Clean:
No break in sterile technique, site not inflamed or infected eg breast surgery
Clean-contaminated:
Respiratory, gut or genito-urinary tract entered but no contamination encountered eg appendectomy
Contaminated:
Major break in sterile technique, spillage from GI tract or acute inflammation encountered
Dirty:
Acute inflammation with pus encountered / GI tract perforation / old dirty wounds

26
Q

e.g. of surgery and antibiotic prophylaxis - CLEAN

A

No break in sterile technique, site not inflamed or infected eg breast surgery

None (unless implanting)

27
Q

e.g. of surgery and antibiotic prophylaxis - CLEAN-CONTAMINATED

A

Respiratory, gut or genito-urinary tract entered but no contamination encountered eg appendectomy

At induction and 24h post op

28
Q

e.g. of surgery and antibiotic prophylaxis - DIRTY

A

Contaminated:
Major break in sterile technique, spillage from GI tract or acute inflammation encountered
Dirty:
Acute inflammation with pus encountered / GI tract perforation / old dirty wounds

Contaminated or Dirty – at induction and treatment course for 5-7 days post op

29
Q

Why should er try to avoid antibiotics?

A

They carry their own risk
c diff, resistance,
s/e

30
Q

Choice of antibiotic regime depends on

A

Locally agreed policies
Microbiologists & Pharmacist

Choice depends on:

- Likely organism encountered – local resistance patterns
- Cost-effectiveness
- Pharmacokinetics – tissue concentration
31
Q

What route is preferred for antibiotic prophy

A

High tissue concentration at time of incision
iv preferred route
Dose / infusion completed just before incision if iv
Re-administer if long surgery

32
Q

Info on NBM post op

A

Following most surgical procedures, patients can eat and drink that evening
Post GI surgery may be NBM for several days / weeks or have impaired absorption
Regular medicines for underlying disease
- essential to be continued?
Consider alternative routes:
- parenteral - iv/im/sc
- transdermal
- rectal
- via feeding tube
- sub-lingual

33
Q

Info on NBM post op

A

Following most surgical procedures, patients can eat and drink that evening
Post GI surgery may be NBM for several days / weeks or have impaired absorption
Regular medicines for underlying disease
- essential to be continued?
Consider alternative routes:
- parenteral - iv/im/sc
- transdermal
- rectal
- via feeding tube
- sub-lingual

34
Q

4 things to consider post op

A

vTE propylaxis
Antibiotic prophylaxis
PONV
pain

Clinical (32 decks)

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