Exam 3 Surgical Complications Flashcards
Post Op Fever prevalence?
2/3 of pts
Post Op Fever caused by?
Bacteria/toxins-induces cytokines
Trauma-induced cytokines
Cytokines induce?
Pro-inflammatory response
Causes of Post-Op fevers? 7 W’s
Wind = PNA, atelectasis Water = UTI Wound Waste = Low GI (leak/bacteria) Walk = DVT/PE Wonder Why = Abscess Weird drugs = Meds
Post Op fevers: W/U when?
Fever presents > 48 hrs post
Temp > 102
Post Op fevers: W/U should include? (5)
Examine the pt! CBC w/ diff UA w/ Cx Blood Cx CXR
Atelectasis U result of?
U where in lung?
Causes fever when?
Tx?
Thoracic/Up abd surg
General anesth
Base/segmented
Most C cause of fever w/i 1st 48 hrs
Early ambulation, spiro, cough, chest physio
PNA U result of? (3)
W/U? (3)
Tx?
Atelectasis
Aspiration
Mechanical vent
CXR, sputum cx, CBC
ABX
Aspiration C when?
Prevent how? (3)
Old
NG tube
Elevate head
NG suction
Nasotrach suction
Causes of fever POD 3+?
Wind Water Wound Waste Walk Wonder Why Weird drugs
Wind = PE Water = UTI Wound = wound or IV catheter Waste Walk = DVT Wonder Why = Abd/Rectal abscess Weird drugs = Meds
New/unrelated dz
UTI risk factors?
In cath, esp > 2 days
Urine retention/stasis
Seroma is?
C w/?
Benign collection of liquified fat, serum, lymph in SQ under wound
Large skin flaps
Seroma presentation? (3)
Localized/circumscribed swelling
Pressure/discomfort
Occasional drain clear/yellow
Seroma tx? (3)
Suction drain
Aspiration
I&D
Hematoma is?
Why do we care?
Abn collection of blood
U in SQ of wound or abd cavity
Potential 2° infection
Hematoma caused by? (3)
Tx?
Inadequate hemostasis
Depleted clotting factors
Coagulopathy
Fix cause
Evacuate
Dehiscence is?
Why do we care?
Postop separation of abd layers
Risk of evisceration (disembowelment)
Dehiscence most C when?
P causes of dehis?
7-10 days post (upto 20 days)
Hematoma
Infection
Dehiscence presentation? (2)
Sudden/dramatic drain of large vol of salmon-colored fluid
P ripping sensation
Dehiscence tx?
Depends on extent
Wound care to OR
Wound infection most C when?
POD 3-7
POD 2-3 if Strep A or c diff
Wound infection tx? (5)
I&D if fascia intact Wet-to-dry or Silver alginate dressings Wound vac Cx ABX
C. Diff U seen when?
Presentation?
Test?
w/i 72 hrs post
Watery, smelly D
Stool cx for toxin
Intra-Abdominal infections U caused by?
Presentation? (5)
Tests? (3)
Complication (dehiscence)
Abd pain, fever, leukocytosis, tachy, look sick
CXR (free air)
CT
US
Intra-Abdominal infections U result of what microbes? (3)
E. Coli
Enterobact
Bacteroides
Intra-Abdominal infections mgmt? (5)
Laparotomy I&D PerQ drain Debridement ABX
What classes of meds may cause post-op fevers?
ABX
Cardiovascular
Anticonvulsants
Bunch of other stuff
See slide 74
Bacteremia cxs must be from?
two different sites
Bacteremia mgmt? (4)
New IV line Q 3 days
Seal IV lines
ABX
If suppurative (puss-filled), I&D of vein by vascular doc
Decubiti are?
U seen where? (4)
Pressure sores
Sacrum
Occiput
Ischia
Heels
Decubiti grades
I?
II?
III?
IV?
I = Non-blanching erythema of intact skin
II = Superficial, part thickness loss of epiderm and/or derm
III = Full thick loss w/ SQ fat necrosis, P extension to fasica
IV = Full thick loss w/ necrosis of mm, tendon, bone
Decubiti mgmt?
PREVENTION
Debride/freq changes
Wound vac
Abscess mgmt?
Aspiration
P I&D
I&D indicated for?
Done how? (5)
Relief of pain/infection
Open w/ 11# blade Evacuate Irrigate Pack Systemic ABX
