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Post Op Complications > Management > Flashcards

Management Flashcards

1
Q

How would you manage Post-op Haemorrhage?

A

A to E
Direct pressure to the wound
Lie patient on side of wound
IV Access
Fluid resuscitation
Activate the massive haemorrhage protocol for blood transfusion

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2
Q

What is important to ask in this station?

A

Introduce yourself
Confirm name and DOB
What’s been going on?
Brief focused history of presenting complaint
When did this start?
How was it when it started, how is it now?
What surgery did you have?
When was the surgery?
What type of anaesthetic did you have, were you fully asleep?
When was the last time you ate or drank?
Have you been going to the emptying your bowels?
Have you been urinating?
Do you have any other medical conditions?
What medications do you take?
Do you know what medications you’ve been taking since your surgery?
Do you have any allergies?

Look around the bed and at any charts available

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3
Q

What are the main points of post op management?

A

Does the patient need oxygen?
Fluid balance: IV fluids? Urinary catheter?
Drugs: Analgesia, Anti-emetic, Antibiotics
VTE prophylaxis
Escalation

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4
Q

What investigations would you do for Sepsis?

A

Want to find source of infection

Urine dip +/- culture
Chest X-ray (CXR)
Swabs (e.g. surgical wounds)
Operative site assessment (via CT or US imaging)
Cerebrospinal fluid sample (via LP)
Stool culture

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5
Q

How would you manage Sepsis?

A

Involve seniors early
Sepsis 6 bundle
Take blood cultures
Do an ABG for lactate levels
Put in a catheter to monitor urine output
Give O2, IV Fluids, IV antibiotics

If septic shock want to refer to ITU

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6
Q

How do you manage post-op nausea and vomiting?

A

Assess fluid status - give IV fluids
Adequate analgesia
NG Tube insertion

Give a different antiemetic to the one given in theatre

Opioid induced PONV - Ondansetron
Dexamethasone often effective , but usually given at induction

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7
Q

What are the causes of post-op delirium?

A

Hypoxia
Infection
Drugs ( Diuretics, opioids, steroids)
Dehydration
Constipation
Urinary retention
Electrolyte imbalances

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8
Q

How do you manage post-op deleiriem?

A

MMSE
Urinalysis
Bloods ( FBC, U&Es, glucose)
CXR

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9
Q

Management of post-op derlierium?

A

Review their obs
Review their drug chart
Look for any signs of infection, constipation or urinary retention
Ensure adequate hydration
Identify cause and treat
Orientate patient in a quiet area to deescalate
Promote regular sleeping patterns
Can use Haloperidol to sedate if de-escaltion doesn’t work

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10
Q

What is the management of Atelectasis?

A

Ensure adequate pain control
Deep breathing exercises
Chest physiotherapy

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11
Q

What would post-op pyrexia on day 1-2 indicate?

A

Could be routine
Respiratory source

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12
Q

What could post-op pyrexia on day 3-5 indicate?

A

Respiratory source
Urinary source

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13
Q

What could pyrexia on day 5-7 be caused by?

A

Surgical site infection or abscess/collection formation

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14
Q

What could pyrexia any day indicate?

A

Infected IV Lines or central lines

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15
Q

What is a useful mnemonic for post-op pyrexia?

A

Wind - respiratory
Water - urinary
Walk - DVT
Wound - infection of wound site
Wonder about drugs

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16
Q

What are the six Cs of pyrexia on the wards?

A

Chest (infection)
Cut (wound infection)
Catheter (UTI)
Collections (abdomen, pelvic etc.)
Calves (DVT)
Cannula (infection, if applicable)
Central line (infection, if applicable)

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17
Q

What is the management for post-op fever?

A

SEPSIS 6 bundle
If sepsis suspected early senior review
Any identified infection treated with empiric antibiotics

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18
Q

How would you manage ARDS?

A

Ventilation with low tidal volume
Maintaining the minimum intravascular volume required to ensure adequate tissue perfusion, limiting oedema
Positive end-expiratory pressur
Treatment of underlying cause

19
Q

What are some causes of ARDS?

A

Pneumonia
Aspiration
Fat embolism
Sepsis
Acute pancreatitis

20
Q

What is the management for a DVT/PE?

A

DOAC for 3 months
PE - ECG, CTPA and Thrombolysis with Alteplase

If they are remaining on the ward
Thromboembolic stockings
LMWH

21
Q

What is the treatment for Fat embolism?

A

Respiratory support , often causes ARDS
Severe - mechanical ventilation

22
Q

What is the investigations for an anastomotic leak?

A

FBC, CRP, and clotting screen
ABG - pH and lactate
CT Abdomen with contrast to find source

23
Q

What is the management for an anastomotic leak?

A

NBM
Broad spectrum antibiotic cover
Urinary catheter to enable fluid balance monitoring

Minor - IV ABx, Bowel rest, drain insertion

Systemically unwell, signs of peritonism and large leaks - Surgical intervention , washout refashioning of anastomosis and/or a defunctioning proximal stoma

24
Q

What is the management for Post-op Ileus?

A

NBM
NG Tube
Daily bloods ( FBC, U&Es)
Stop any offending medications e.g opioids
Encourage mobilisation
Can give stimulant laxative e.g Senna

25
Q

What is the management of post-op constipation?

A

Adequate hydration
Sufficient dietary fibre, Treating the underlying cause
Encouraging early mobilisation

Opioid induced - stimulant laxative e.g Senna

26
Q

What is the management for post-op pneumonia?

A

It is HAP

O2 therapy aiming for >94%
Aiming for 98-92% if risk of hypercapnic respiratory failure

Adequate hydration and sufficient dietary fibre, treating the underlying cause, and encouraging early mobilisation.

27
Q

What is the management of an AKI?

A

Stop any offending drug
D (Diuretics)
A (ACEi/ARBs)
M (Metformin) - accumulation= lactic acidosis
N (NSAIDs)
also LMWH and Aminoglycoside antibiotics

Assess patient’s fluid status

Pre-renal - give I.V Fluid bolus
Reassess fluid status after 15mins, monitoring urine output after each bolus
Repeat until patient is euvolaemic
Regular U&Es to look at serum creatinine

28
Q

What are some causes of post-op urinary retention?

A

Uncontrolled pain
Constipation
Infection
Anesthetic agents

29
Q

What is the management of Acute Urinary Retention?

A

Withdrawal of any causative agents
SIgnificant retention will require catheterisation
Then a Trial Without catheter should be done , if they enter retention again a new catheter should be inserted

30
Q

What can a UTI causes?

A

Delirium
Sepsis
Acute urinary retention

31
Q

What is the management of a UTI?

A

Ensure adequate hydration
Make to check urine output Antibiotics - Nitrofurantoin , Co-amoxiclav if signs of peritonitis
After getting the MCS can change antibiotic depending on the sensitivity
Change any long-term urethral or suprapubic catheter in-situ in the presence of a UTI

32
Q

What are symptoms of hyperkalaemia?

A

Paraesthesia
Muscle weakness
Nausea and vomiting
Palpitations

33
Q

How do you manage severe hyperkalemia? (>6.5 or ECG changes)

A

Continuous cardiac conitoring
10ml of 10% Calcium Gluconate - stabilises the cardiac membrane
Variable rate insulin with ( typically 200ml of 20% glucose with 10U of insulin over 30mins) - drives K+ into cells, dextrose prevents hypoglycaemia
Salbutamol nebulisers - drives K+ into cells
Resistant hyperkalaemia potentially warranting haemodialysis

34
Q

What is the management for hypernatraemia?

A

Correct with Na+ levels at a suitable rate with oral rehydration, not too quickly due to risk cerebral oedema

35
Q

What is the symptoms of hypoglycaemia?

A

Sweating
Tingling lips or extremities, Tremor
Dizziness
Slurred speech
Pallor
Confusion
Tachycardia
Tachypnoea
Focal neurology
Reduced consciousness

36
Q

What surgeries increase the risk of hypoglycaemia?

A

Post-gastrectomy or gastric bypass surgery

37
Q

What is the management for hypoglycaemia?

A

A-E approach

If the patient is conscious, give oral glucose (such as 10g GlucoGel)
Monitor the capillary blood glucose levels every 1-2hrs until stable and ensure patient eats complex carbohydrates (e.g. bread) to maintain their BM

If the patient is unconscious, start by protecting their airway and start high flow O2. Gain intravenous access and give intravenous glucose (such as 100ml of 20% dextrose IV)
Can also give IM Glucagon If can’t gain IV access

38
Q

What is the treatment for hypokalemia?

A

Treatment of underlying cause
Mild - Oral K+ supplements
Moderate-Severe or unable to take oral supplements - IV K+ replacement
Daily U&Es

39
Q

What is the management for hyponatraemia?

A

Intravenous fluids (such as 0.9% sodium chloride) for better control over oral
Monitor renal function and electrolyte levels regularly,

40
Q

What are the symptoms of hyponatraemia?

A

Neurological signs, such as malaise, headache, and confusion, before progressing to reduced consciousness and seizures

41
Q

What is the management for a surgical site infection?

A

Remove any sutures and clips
Drain pus if required
Take a wound swab
Pack the wound
Empirical antibiotics, change depending on results of swab MCS

42
Q

What is the management for wound dehiscence?

A

Superficial - simple wound care , wound packing with sterile saline soaked gauze
More extensive wound dehiscence may require negative pressure wound therapy to aid in healing.

Full wound dehiscence

A to E approach
Analgesia
Broad spectrum Antibiotics
Cover wound with saline-soaked gauze
Urgent return to theatre for resuturing

43
Q

What are risk factors for wound dehiscence?

A

Increasing age
Diabetes mellitus
Steroids
Smoking
Obesity or malnutrition
Emergency surgery
Length of operation (>6hrs)
Wound infection
Prolonged ventilation
Poor tissue perfusion (e.g. post-operative hypotension)

Post Op Complications (1 decks)

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