Managing post-op ortho patients Flashcards
What types of fluids can be lost?
insensible
blood
third space loss
Saline and hartmann’s are examples of which type of fluids
crystalloids
Name one colloid
albumin
FFP
Name one common organism that causes infection in hip arthroplasty
coagulase negative staph- 67%
staph aureus
strep
e. coli
List three risk factors for higher incidence of infection in trauma
open wounds
diabetes
obesity
vascular disease
prolonged procedure time
older patients
immune impairment
nutritional deficiencies
What should you do when you suspect infection post op?
take swabs of specimen for baseline testing and inflammatory markers
do not treat with antbiotics- first contact orthopaedic team
only commence antibiotics if sepsis and specimen obtained
What is the rule with antibiotics in treating post op infection?
do not treat until you have obtained specimen as infection can be quite deep and pre antibiotics is the best chance of isolating organism
What is the definition of post-operative AKI
elevated creatinine
reduced urine output
What is the pathogenesis of AKI post-op?
hypotension leads to pro-inflammatory state
increase in vasoconstrictive mediators
tubular ischaemia and injury
List two risk factors for post op AKI
hypovolaemia
anaesthesia
nephrotoxic agents
prophylactic antibiotics
older patients
pre existing chronic kidney disease
diabetes
liver disease
hypertension
use of ACEi
Risk factors for compartment syndrome?
trauma with crushing injury
trauma with long lie
long bone fractures
coagulopathy
vascular injury to limb
ischaemia of tissues- e.g. prolonged tourniquet time
What can mask compartment syndrome?
nerve block/spinal anaesthesia
Why are othopaedic patients at high risk of thromboembolic disease?
blood stasis- tourniquet, immobilisation
endothelial injury
hypercoagulability- trauma increases thromboplastins due to blood loss
Risk factors for thomboembolic disease in ortho patients?
Older patients
Obesity
Varicose veins
Family history of VTE
Thrombophilia
Combined OCP / HRT
Immobility
Immobility due to travel
Lower limb fracture
Spinal cord injury
Lower limb surgery
What is the preventative management of thromboembolic disease?
compression stockings
early immobilization
Aspirin
DOAC
