OnlineMedEd: Surgery: General - "Other Postop Issues" Flashcards

1
Q

Review the workup of postop chest pain.

A

Must rule out MI and PE:

  • MI: do an ECG and troponins
  • PE: US and CTA
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2
Q

How is MI management different in a postop patient?

A

You cannot use tPA because they just had surgery, so you must use PCI and heparin.

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3
Q

Give a differential for postop AMS.

A

•Electrolyte imbalance (commonly in sodium or calcium)
–get a BMP and give fluids

•Sundowning
–antipsychotics

•Hypoxemia (PE, ARDS, PNA)
–Disease-specific

• DTs
–Give benzos

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4
Q

How should you work up urinary retention postop?

A

•Evaluate those making less than 0.5 ml/cc/hr.
-If they have the urge to go but cannot, do an in-and-out catheter for presumed obstruction.
- If they do not have the urge but they are making some urine, give them a 500 cc bolus (for presumed mild AKI). If this does not correct it, then proceed to evaluate for intrinsic etiologies of AKI.
- If they do not have the urge and they have made no urine, check the catheter for a kink.
-

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5
Q

Ileus presents with ________________.

A

dilation of the entire bowel: small and large

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6
Q

How can you treat ileus?

A
  • IVF
  • Potassium
  • Moving around
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7
Q

How can you differentiate ileus and obstruction?

A

X-ray

KUB shows uniform dilation of the entire bowels while obstruction shows dilations up to a point and then shrunken bowel after.

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8
Q

Describe the management of dehiscence.

A
  • Diagnosed clinically: skin and subcutaneous breakdown with leakage of serosanguinous fluid
  • Binders
  • Avoid straining
  • Reoperate (electively) to close the wound
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9
Q

How should you handle eviscerations?

A
  • Warm saline dressings
  • OR emergently
  • Do not push it back in immediately –doing this without washing it out will cause infections
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10
Q

What do you need to rule out in postop fistulas?

A
Think of a FETID fistula: 
•Foreign body
• Epithelialization
•Tumor
•Inflammation / IBD / Irradiation 
•Distal obstruction
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