Cardiorespiratory Post-Op Complications Flashcards
what is atelectasis?
the partial collapse of the small airways in the lungs
true or false: most patients develop some form of atelectasis
true.
post-op patients develop it at varying degrees, compromising lung function
how does atelectasis increase the risk of lung complications?
reduced airway expansion leads to an accumulation of pulmonary secretions.
this can cause hypoxaemia, reduced lung compliance, respiratory infections, acute respiratory failure
what are the risk factors for atelectasis?
age smoking general anaesthesia duration of surgery lung or neuromuscular disease prolonged bed rest poor post-op pain control
what are the clinical signs of atelectasis?
increased respiratory rate
reduced oxygen saturations
patient may have fine crackles on auscultation
how long does it usually take for a patient to show signs of post-op atelectasis?
symptoms normally develop within 24 hours of surgery
what is first line imaging in atelectasis and what would it show?
chest x-ray
small areas of airway collapse, however it may also be inconclusive
what other imaging can be taken in atelectasis and why?
CT imaging
it has good sensitivity in identifying renal collapse and reduced airway volume
how is atelectasis managed?
deep breathing exercises and chest physiotherapy
why is pain control important in a patient with atelectasis?
if a patient is in pain, they will not be able to deep breathe and adequately clear secretions from their lungs
what further treatment is given to atelectasis patients if physiotherapy doesn’t work?
bronchoscopy is done to try and clear secretions
how do you prevent atelectasis?
patients who have undergone major surgery should be referred for chest physiotherapy to prevent atelectasis
what are the four different kinds of pneumonia?
- community acquired pneumonia (CAP)
- hospital acquired pneumonia (HAP)
- aspirational pneumonia
- immunocompromised pneumonia
what is the definition of hospital acquired pneumonia?
pneumonia that has onset >48 hours since being in hospital
why are post-operative patients more at risk for developing pneumonia?
- reduced chest ventilation
- change in commensals
- debilitation
- intubation
why do post-op patients have reduced chest ventilation and how can this lead to pneumonia?
they have reduced mobility and are bedridden leading to an inability to fully ventilate their lungs - accumulating secretions which then become infected
why do post-op patients have a change in commensals and how can this lead to pneumonia?
patients are exposed to more bacteria in a hospital and can be effected by them
common ones that cause HAP: e. coli, s. aureus, s. pneumoniae, pseudomonas
why are post-op patients debilitates and how can this lead to pneumonia?
post-op patients are likely to have co-morbidities or be ill, compromising their immune system and predisposing to infections
what are the risk factors for pneumonia?
age smoking known respiratory disease poor mobility immunosuppression underlying co-morbidities e.g. DM or CVD
what are the clinical features of pneumonia?
cough, dyspnoea, chest pain, pyrexia, general malaise
what are the clinical signs of pneumonia?
reduced O2 sats
increased resp rate and heart rate
on examination: bronchial breath sounds, inspiratory crackles and dull percussion
what are the differential diagnoses of pneumonia?
acute heart failure acute coronary syndrome PE asthma COPD exacerbation pleural effusion empyema
what laboratory investigations should be done if you suspect post-op pneumonia?
- routine bloods: FBC, CRP, U&Es to show evidence of inflammatory response
- ABG if patients O2 sats are low
- sputum sample
- blood cultures
what imaging should be done if you suspect post-op pneumonia?
chest x-ray to confirm the infection and if either lobar or bronchopneumonia
how do you manage hospital acquired pneumonia?
O2 therapy targeting 94% sats
antibiotics
what antibiotic should be given to treat hospital acquired pneumonia?
co-amoxiclav
true or false: all patients should have a target sats of 94% in O2 therapy
false.
COPD patients should have a target of 88%-92% because of the risk of hypercapnic respiratory failure
what are the major complications of pneumonia?
- pleural effusion
- empyema
- respiratory failure
- sepsis
what lobes of the lung does aspirational pneuminitis tend to affect and why?
right middle or lower lung lobes
due to the anatomy of the bronchi
what are the risk factors in surgical patients for aspiration?
- reduced GCS (secondary to anaesthetic)
- iatrogenic interventions (e.g. misplaced NG tube)
- prolonged vomiting
- oesophageal strictures or fistula
- post-abdominal surgery
what are the risk factors for developing a VTE?
age previous VTE smoking pregnancy or post-partum recent surgery prolonged immobility HRT or COCP cancer obesity
what is DVT?
formation of a blood clot in the deep veins of a limb - most commonly the legs
what are the clinical features of DVT?
- unilateral leg pain
- swelling
- low-grade pyrexia
- pitting oedema
- tenderness
true or false: most DVTs are asymptomatic
true.
how do you manage a DVT?
direct oral anticoagulants (DOACs) is first line
what drugs are considered DOACs and what is their mechanism of action?
apixaban, rivaroxaban, edoxaban are factor Xa inhibitors
dabigatran is a thrombin inhibitor
what is the treatment regime for patients with a DVT?
anticoagulants should be continued for at least 3 months
what are the clinical features of a pulmonary embolism?
- sudden onset dyspnoea
- pleuritic chest pain
- cough or haemoptysis
what are the clinical signs of a pulmonary embolism?
- tachycardia
- tachypnoea
- pyrexia
- signs of DVT
what are the common investigations done in a suspected DVT?
- ECG as a common differential is an MI
- CT pulmonary angiography to show the PE
what is the management for a stable PE?
the same as a DVT
what is the management for a PE with complications?
thrombolysis may be considered
what is the management for recurrent PEs?
an IVC filter may be considered
