Lecture 13: Post-Op Complications/Care Flashcards
MC pulmonary complication
atelectasis
What temp defines a Post-op fever
> 38 C
note: fever is not always infectious
What is the Tx for Malignant HYPERthermia & Neuroepileptic Malignant Syndrome?
Dantrolene
What is the mostly likely drug combination to cause Serotonin Syndrome?
SSRIs and Linezolid
What type of ABX Tx do you do for Fever of unknown cause?
Broad Spectrum ABXs (combo of best gram +, gram -, and anaerobic drug)
NOT the -penems
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?
Pull back on the unneeded ABXs
- only leave gram + coverage (Ex: Cephalosporins, PCNs, Clindamycin)
What is the most common cause & bug leading to nosocomial bloodstream infections
Cause = CVC
bug = Coag-negative staph
What is the typical cause of atelectasis post-operatively and what does atelectasis predispose you to if it goes on for >72 hrs?
D/t splinting (pain)
Predisposes to PNA
What is the typical cause of atelectasis post-operatively and what does atelectasis predispose you to if it goes on for >72 hrs?
D/t splinting (pain)
Predisposes to PNA
What combination leads to the highest cardiac complication risk for post-op patients?
lengthy surgery + urgent surgery (no pre-op risk stratif) + uncontrolled bleeding + HoTN
What is the MC post op cardiac complication?
Dysrhythmias
What medication is used for extended DVT prophylaxis?
Lovenox (LMWH)
for 10-35 days
When should you consider alternative interventions for anticoag DVT prophylaxis?
- Active bleed
- Current oral anticoagulants
- Glycoprotein II/IIIa Inhibitors
- antiplatelet agents
- Hx of HIT
What are the options for mechanical thromboprophylaxis (alt to drugs)
SCDS or Compression Stockings
What are the complications of DVT prophylaxis?
**HIT
Hematoma, Mucosal bleeding, Re-operation
What is Virchow’s Triad
- venous stasis,
- hypercoagulability
- vascular injury
What is the diagnostic test of choice for DVTs? What are you looking for that suggests a DVT?
Venous Duplex US
Vein not compressible - likely DVT
What are the 3 anticoagulation options used to Tx DVTs?
How long do you Tx for?
- Coumadin (Warfarin)
- DOAC/NOACs
- Pradaxa (Dabigitran)
Tx for 3 months
Why are IVC filters used to Tx DVTs?
To prevent PE from traveling to heart/brain
- inserted into the IVC to trap venous emboli (clot gets stuck in the filter)
When are IVC filters inserted to Tx DVTs?
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
Where do most PE arise from?
Proximal leg veins (iliac, femoral, popliteal)
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?
Pulmonary Embolism
1st line Dx test = CTPA
CT pulmonary angiography
What are the treatment options for a pt w/a PE?
Supportive Therapy, Anticoagulation, Thrombolysis meds
Consider IVC filter placement
In post-op patients what is the 1st sign of Renal dysfunction?
urine output
What causes PRErenal dysfunction in post op patients?
Prerenal = decr blood flow to kidneys
Commonly d/t hypovolemia during an operation
Others:
What causes INTRArenal dysfunction in post op patients?
ATN, Amingolycosides, NSAIDs, IV contrast
Others: blood transfusion, amphotericin B
What causes POSTrenal dysfunction in post op patients?
any sort of obstruction (BPH)
What combination of RFs lead to a very high risk of stroke post-operatively due to poor cerebral perfusion?
Elderly + atherosclerotic Dz + HoTN
What two GI diseases increase your risk of post-op seizures?
UC and Crohn’s
What is the main Tx for EtoH withdrawal?
BZs
What tool is used to assess medication choice and dosage for alcohol withdrawal?
CIWA scale
Clinical Institute Withdrawal Assessment for Alcohol
What are the Pre-op RFs for delirium?
Old age, EtOH use, Cognitive impairment, Poor fxtional status, Ab values (Na, K, gluc), Surgery (Aortic, thoracic, hip)
What are the Post-op RFs for delirium?
Meds (BZs, opioids, anesthetics)
HCT low (< 30%)
Urinary catheters
What are some prevention strategies to prevent delirium?
Avoid narcotic, BZs & dehydration
Control their pain
Note: others not included
What are 5 major causes of post-op fever based on timeframe?
“1, 3, 5, 7”
- Wind (atelectasis) - Day 1
- Water (UTI) - Day 3
- Wound (SSI) - Day 5
- Walking (DVT/PE) - Day 7
- Wonder Drugs - anytime
