AH2 ‐ Common Periop Complications - General Complications After surgery - Dr Aramovic Flashcards
This is very examinable topic!
What are the learning objectives form this lecture?
What are definitions you need to know (complications - define in terms of this setting)
E.g technical vs avoidable vs non techncal complications
How else can we define post-opertive surgical complications?
What is the Clavien-Dindo classification of post-opertive complications
What is the general time frame of complications (as per timing post op)
Wind, Water,
How can we prevent surgical complications as junior doctors? (need to know this for exams)
What are respiratory complications associated with surgery? (atelectasis)
- Most common with painful thoracic and upper abdominal operations: (why is this important) - Pain is major inhibitory factor in upper GI?resp surgery
Respiratory complication:
How can aspiration be caused????? (accidentally)
How can we prevent asipration as risk post-operatively
What complications are associated with aspiration - How can we identitfy and treat these patients
How do we prevent and recognise DVT/PE risk in patients? What management do we need to provide?
- Adequate fluid
- adequate pain relief so important
- Mechanical and chemical prophylaxis
- Early mobilastion post surgically
Suspect if there is unilateral, leg pain, or swelling, low grade fever, hypoxaemia, air hunger, pleuritic chest pain or haemoptysis
How do we prevent endocarditis?
- PROVIDE antibiotic prophylaxis as there is a risk of nosocomial infection ie, an intravenous devices (heart prosthetics)
What are important coagulation disorders to look out for in surgical patients? How do we manage these patients optimally?
- Medical anticoagulation most common cause of disruption these days
What are the 4 major medical anticoagulants? (need to cease and monitor in surgical patients)
What questions should ask yourself when stopping anticoagulation post-opertively?
1) is it safe to stop?
2) Is bridging anticoagulation required
3) Is it safe to operative without stopping anticoagulation
When should
When is bridging anticoagulation needed!
What are important surgical complications with patients with Diabetes? What medications should start and stop?
Whose in charge?
NEED to have diabetes well controlled pre-op!
If needing insulin- halving normal insulin dose is normally enough.
Non-insuling dependent - omit oral hypoglycaemics whilst fasting pre-op, and if necessary insulin sliding scale post op until tolerating a diet
How do we define a fever in post-op patient?
How do we manage a post op fever?
(The type of fever and time after surgery may suggest the cause)
How do we define post opertive tachycardia?
What do we need to do to manage this? (need to work out cause)
What can be causing this (3 marks)
Case 1: identify 5 things that could lead to complications
- Risk of aspiration -
- Risk of atelectasis- distended
- AKI
- Haemorrhage (apixaban) - 36 hours increased
- Euglcaemic ketoacidosis
- HTN - may present as haemorrhage
- Post-op
- Atrial Tachycardia
- Endocarditis
- Diabetes needs to be optimized
True or false
- False cannot be reversed
- True - NGT
- True
- False
- True
- (for patient with anaemia needs to be given pre-op) - thus false
What are the possible explanations for this observation chart day 1-3 post op?
What other information do you need/
Atelectasis- leading to pneumonia
POssible causes of fever, tahcycardia, poor oxygentation (due to rigors) , High RR, ?????
Day 4- think IV cannula causing bactraemia
What is occuring here?
What occurs day 9 post operativey with such detirioation?
What are important medico-legal aspects of complications?
Consent?Rapport? Communication, compassion, professional proficiency are vital
Dont avoid or abandon the patient!
Do say sorry for the way things turn out?
