post op Flashcards
causes for post op pyrexia
1) wind (one to two days post op) –> pneumonia / atelacases
2) water (3 days) - UTI
3) wound infection - 5 days
4) DVT - 5/6 days
-can be normal straight after surgery
IX for post op pyrexia
so septic screen including wound swabs/ UTI screen/may do imaging
when would an anastomotic leak present
3-5 days post op
RF for anastomotic leak
DM, immunosuppression, corticosteroids, emergency surgery, increased time length of operation
IX for anastomotic leak
CT AP with contrast
MX of anastomotic leak
Anastomotic leak normally presents 3-5 days post surgery
-worsening symptoms –> pain, vomiting, fever
-Ix –> FBC, clotting, CRP, lactate and CT with contrast
-Mx –> NBM, IV abx, catheter for urinary output
-minor leaks may be sufficiently treated with bowel rest and antibiotics
-more major leaks will need surgery –> LAPAROTOMY, WASHOUT, REFASHIONING OF THE ANASTOMOSIS
Rf for atelectasis
immobility, smoking, poor pain control
Ix for atelectasis
CXR
when does a wound infection normally present
5-7 days post op
Rf for wound infections
diabetic, malnutrition, obese
Mx of wound infection
remove sutures + give abx, can use negative pressure dressings
whats a RF for wound dehiscence
excessive coughing
oliguria defined as
<0.5ml/kg/hour for 2 hours or daily output <400ml
whats the difference between a superficial and a deep wound dehiscence
superficial has the rectus sheath in tact and can be washed with saline and packed with smile gauze where as in full dehiscence patient needs to go back to theatre
causes of poor urine output post op
1) retention (BPH)
2) AKI
3) constipation
4) disruption of normal neurological signs
5) UTI
if vomiting starts how many hours after op does pt need CT
48 hours (exclude anastomotic leak)
complications of vomiting post op
wound dehiscence, dehydration, aspiration pneumonia
other complications post op
pain, constipation, diarrhoea, POCD
how is POCD different to delirium
POCD - problems with higher mental tasks like cross words but delirium is acute confusion
which anaesthetic is good if patient is haemodynamically unstable (low BP)
ketamine
how long is a post op ileum normal for
3 days, after this needs investigating
RF of needing a blood transfusion in surgery
-anaemia pre operatively
-those on anticoagulants
-thrombocytopenia
what are option for increasing Hb pre op
1) oral iron (this takes 2-3 months)
2) IV iron - this takes 2 weeks
how can the need for a blood transfusion intraoperatively be prevented
intraoperative cell salvage, tranexamic acid
