Lecture 13: Post-Op Complications/Care

Question 1

MC pulmonary complication

Answer 1

atelectasis

Question 2

What temp defines a Post-op fever

Answer 2

> 38 C

note: fever is not always infectious

Question 3

What is the Tx for Malignant HYPERthermia & Neuroepileptic Malignant Syndrome?

Answer 3

Dantrolene

Question 4

What is the mostly likely drug combination to cause Serotonin Syndrome?

Answer 4

SSRIs and Linezolid

Question 5

What type of ABX Tx do you do for Fever of unknown cause?

Answer 5

Broad Spectrum ABXs (combo of best gram +, gram -, and anaerobic drug)

NOT the -penems

Question 6

A patient was put on a combination of broad spectrum ABXs for a fever of unknown cause and the culture comes back as a gram + infection, what should you do next?

Answer 6

Pull back on the unneeded ABXs

- only leave gram + coverage (Ex: Cephalosporins, PCNs, Clindamycin)

Question 7

What is the most common cause & bug leading to nosocomial bloodstream infections

Answer 7

Cause = CVC

bug = Coag-negative staph

Question 8

What is the typical cause of atelectasis post-operatively and what does atelectasis predispose you to if it goes on for >72 hrs?

Answer 8

D/t splinting (pain)

Predisposes to PNA

Question 9

What is the typical cause of atelectasis post-operatively and what does atelectasis predispose you to if it goes on for >72 hrs?

Answer 9

D/t splinting (pain)

Predisposes to PNA

Question 10

What combination leads to the highest cardiac complication risk for post-op patients?

Answer 10

lengthy surgery + urgent surgery (no pre-op risk stratif) + uncontrolled bleeding + HoTN

Question 11

What is the MC post op cardiac complication?

Answer 11

Dysrhythmias

Question 12

What medication is used for extended DVT prophylaxis?

Answer 12

Lovenox (LMWH)

for 10-35 days

Question 13

When should you consider alternative interventions for anticoag DVT prophylaxis?

Answer 13

1. Active bleed
2. Current oral anticoagulants
3. Glycoprotein II/IIIa Inhibitors
4. antiplatelet agents
5. Hx of HIT

Question 14

What are the options for mechanical thromboprophylaxis (alt to drugs)

Answer 14

SCDS or Compression Stockings

Question 15

What are the complications of DVT prophylaxis?

Answer 15

**HIT

Hematoma, Mucosal bleeding, Re-operation

Question 16

What is Virchow’s Triad

Answer 16

1. venous stasis,
2. hypercoagulability
3. vascular injury

Question 17

What is the diagnostic test of choice for DVTs? What are you looking for that suggests a DVT?

Answer 17

Venous Duplex US

Vein not compressible - likely DVT

Question 18

What are the 3 anticoagulation options used to Tx DVTs?

How long do you Tx for?

Answer 18

1. Coumadin (Warfarin)
2. DOAC/NOACs
3. Pradaxa (Dabigitran)

Tx for 3 months

Question 19

Why are IVC filters used to Tx DVTs?

Answer 19

To prevent PE from traveling to heart/brain

- inserted into the IVC to trap venous emboli (clot gets stuck in the filter)

Question 20

When are IVC filters inserted to Tx DVTs?

Answer 20

Reserved for pts w/proximal DVTs and CIs to anticoag

Also: At risk for DVT/PE pts who can’t take thinners,
Pts who clot despite anticoag

Question 21

Where do most PE arise from?

Answer 21

Proximal leg veins (iliac, femoral, popliteal)

Question 22

A patient presents w/ sudden onset of rapid dyspnea, pleuritic chest pain/cough, HoTN and calf pain/swelling, what is the most likely Dx and what should you do to confirm the Dx?

Answer 22

Pulmonary Embolism

1st line Dx test = CTPA
CT pulmonary angiography

Question 23

What are the treatment options for a pt w/a PE?

Answer 23

Supportive Therapy, Anticoagulation, Thrombolysis meds

Consider IVC filter placement

Question 24

In post-op patients what is the 1st sign of Renal dysfunction?

Answer 24

urine output

Question 25

What causes PRErenal dysfunction in post op patients?

Answer 25

Prerenal = decr blood flow to kidneys

Commonly d/t hypovolemia during an operation
Others:

Question 26

What causes INTRArenal dysfunction in post op patients?

Answer 26

ATN, Amingolycosides, NSAIDs, IV contrast

Others: blood transfusion, amphotericin B

Question 27

What causes POSTrenal dysfunction in post op patients?

Answer 27

any sort of obstruction (BPH)

Question 28

What combination of RFs lead to a very high risk of stroke post-operatively due to poor cerebral perfusion?

Answer 28

Elderly + atherosclerotic Dz + HoTN

Question 29

What two GI diseases increase your risk of post-op seizures?

Answer 29

UC and Crohn’s

Question 30

What is the main Tx for EtoH withdrawal?

Answer 30

BZs

Question 31

What tool is used to assess medication choice and dosage for alcohol withdrawal?

Answer 31

CIWA scale

Clinical Institute Withdrawal Assessment for Alcohol

Question 32

What are the Pre-op RFs for delirium?

Answer 32

Old age, EtOH use, Cognitive impairment, Poor fxtional status, Ab values (Na, K, gluc), Surgery (Aortic, thoracic, hip)

Question 33

What are the Post-op RFs for delirium?

Answer 33

Meds (BZs, opioids, anesthetics)
HCT low (< 30%)
Urinary catheters

Question 34

What are some prevention strategies to prevent delirium?

Answer 34

Avoid narcotic, BZs & dehydration
Control their pain

Note: others not included

Question 35

What are 5 major causes of post-op fever based on timeframe?

Answer 35

“1, 3, 5, 7”

1. Wind (atelectasis) - Day 1
2. Water (UTI) - Day 3
3. Wound (SSI) - Day 5
4. Walking (DVT/PE) - Day 7
5. Wonder Drugs - anytime