Post Op

Question 0

Fever spikes within an hour of invasive procedures suggest? Management?

Fever spikes and severe wound pain within hours of surgery suggest?

Answer 0

Bacteremia. Blood cultures x3 + empiric Antibiotics

Gas gangrene

Question 1

Malignant hyperthermia – develops when? Findings? Treat with?

Answer 1

Shortly after the onset of anesthetic (halothane or succinylcholine)

#Temperature over 104
#Metabolic acidosis
#Hypercalcemia

IV dantrolene, oxygen, cooling blankets

Question 2

Postoperative fever is caused (sequentially in time) by:

Answer 2

Day 0: Wind (atelectasis, pneumonia)
Day 3: Water (UTI)
Day 5: Walking (Deep venous thrombophlebitis)
Day 7-14: Wound (infection, abscess)

Question 3

General Therapy for atelectasis?

Ultimate therapy?

Answer 3

Deep breathing, postural drainage, incentive spirometry

Ultimate therapy – bronchoscopy

Question 4

Best diagnostic modality for deep thrombophlebitis? Management?

Answer 4

Doppler

Anticoagulate with heparin

Question 5

Perioperative myocardial infarction – most commonly triggered by? Treatment that cannot be used in this setting?

Postoperative MI – when?

Mortality?

Answer 5

Hypovolemia; clot busters

POD# 2-3

50-90%

Question 6

Any suspected pulmonary embolus must have what findings? Management?

Answer 6

Elevated CVP and hypoxemia/hypocapnia

1. CT angio
2. Heparinization
   3 Greenfield (IVC) filter if PEs recur

Question 7

Risk factors for thromboembolism? (I.e. give anticoagulation to patients with?)

Answer 7

#Age over 40
#Pelvic/leg fractures
#central Venus catheter
#Anticipated prolonged catheterization
#Venus injury

Question 8

Management of aspiration? Don’t give?

Answer 8

Lavage, bronchodilators, respiratory support

Don’t give steroids

Question 9

Intraoperative tension pneumothorax – seen in patients with? Cause? Course? Management?

Answer 9

Weakened/traumatize lungs – chronic TB, recent blunt trauma with punctures by broken ribs

Positive pressure breathing

BP steadily declines, CVT steadily rises

#If open abdomen, quick decompression through diaphragm
#Needle through anterior chest wall into pleural space

Question 10

Main treatment for ARDS?

Answer 10

PEEP

Question 11

Alcohol withdrawal post surgery? Management?

Answer 11

Hallucinations and combativeness after POD2

IV Betanzos or intravenous alcohol

Question 12

Why would a postop patient become hyponatremic?

Answer 12

Given sodium free IV fluids (D5W) due to high levels of ADH (ADH triggered by trauma)

Question 13

Ammonium intoxication seen in what patient? Symptoms?

Answer 13

Cirrhotic patient with portocaval shunt bleeding esophageal varices

Coma