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Q4 EM Surg > Exam 3 Surgical Complications > Flashcards

Exam 3 Surgical Complications Flashcards

1
Q

Post Op Fever prevalence?

A

2/3 of pts

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2
Q

Post Op Fever caused by?

A

Bacteria/toxins-induces cytokines

Trauma-induced cytokines

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3
Q

Cytokines induce?

A

Pro-inflammatory response

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4
Q

Causes of Post-Op fevers? 7 W’s

A 
Wind = PNA, atelectasis
Water = UTI
Wound
Waste = Low GI (leak/bacteria)
Walk = DVT/PE
Wonder Why = Abscess
Weird drugs =  Meds
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5
Q

Post Op fevers: W/U when?

A

Fever presents > 48 hrs post

Temp > 102

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6
Q

Post Op fevers: W/U should include? (5)

A 
Examine the pt!
CBC w/ diff
UA w/ Cx
Blood Cx
CXR
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7
Q

Atelectasis U result of?

U where in lung?

Causes fever when?

Tx?

A

Thoracic/Up abd surg
General anesth

Base/segmented

Most C cause of fever w/i 1st 48 hrs

Early ambulation, spiro, cough, chest physio

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8
Q

PNA U result of? (3)

W/U? (3)

Tx?

A

Atelectasis
Aspiration
Mechanical vent

CXR, sputum cx, CBC

ABX

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9
Q

Aspiration C when?

Prevent how? (3)

A

Old
NG tube

Elevate head
NG suction
Nasotrach suction

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10
Q

Causes of fever POD 3+?

Wind
Water
Wound
Waste
Walk
Wonder Why
Weird drugs
A 
Wind = PE
Water = UTI
Wound = wound or IV catheter
Waste
Walk = DVT
Wonder Why = Abd/Rectal abscess
Weird drugs = Meds

New/unrelated dz

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11
Q

UTI risk factors?

A

In cath, esp > 2 days

Urine retention/stasis

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12
Q

Seroma is?

C w/?

A

Benign collection of liquified fat, serum, lymph in SQ under wound

Large skin flaps

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13
Q

Seroma presentation? (3)

A

Localized/circumscribed swelling
Pressure/discomfort
Occasional drain clear/yellow

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14
Q

Seroma tx? (3)

A

Suction drain
Aspiration
I&D

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15
Q

Hematoma is?

Why do we care?

A

Abn collection of blood
U in SQ of wound or abd cavity

Potential 2° infection

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16
Q

Hematoma caused by? (3)

Tx?

A

Inadequate hemostasis
Depleted clotting factors
Coagulopathy

Fix cause
Evacuate

17
Q

Dehiscence is?

Why do we care?

A

Postop separation of abd layers

Risk of evisceration (disembowelment)

18
Q

Dehiscence most C when?

P causes of dehis?

A

7-10 days post (upto 20 days)

Hematoma
Infection

19
Q

Dehiscence presentation? (2)

A

Sudden/dramatic drain of large vol of salmon-colored fluid

P ripping sensation

20
Q

Dehiscence tx?

A

Depends on extent

Wound care to OR

21
Q

Wound infection most C when?

A

POD 3-7

POD 2-3 if Strep A or c diff

22
Q

Wound infection tx? (5)

A 
I&D if fascia intact
Wet-to-dry or Silver alginate dressings
Wound vac
Cx
ABX
23
Q

C. Diff U seen when?

Presentation?

Test?

A

w/i 72 hrs post

Watery, smelly D

Stool cx for toxin

24
Q

Intra-Abdominal infections U caused by?

Presentation? (5)

Tests? (3)

A

Complication (dehiscence)

Abd pain, fever, leukocytosis, tachy, look sick

CXR (free air)
CT
US

25
Q

Intra-Abdominal infections U result of what microbes? (3)

A

E. Coli
Enterobact
Bacteroides

26
Q

Intra-Abdominal infections mgmt? (5)

A 
Laparotomy
I&D
PerQ drain
Debridement
ABX
27
Q

What classes of meds may cause post-op fevers?

A

ABX
Cardiovascular
Anticonvulsants
Bunch of other stuff

See slide 74

28
Q

Bacteremia cxs must be from?

A

two different sites

29
Q

Bacteremia mgmt? (4)

A

New IV line Q 3 days
Seal IV lines
ABX
If suppurative (puss-filled), I&D of vein by vascular doc

30
Q

Decubiti are?

U seen where? (4)

A

Pressure sores

Sacrum
Occiput
Ischia
Heels

31
Q

Decubiti grades

I?

II?

III?

IV?

A

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

32
Q

Decubiti mgmt?

A

PREVENTION
Debride/freq changes
Wound vac

33
Q

Abscess mgmt?

A

Aspiration

P I&D

34
Q

I&D indicated for?

Done how? (5)

A

Relief of pain/infection

Open w/ 11# blade
Evacuate
Irrigate
Pack
Systemic ABX

Q4 EM Surg (27 decks)

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