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surgery > post op assessment > Flashcards

post op assessment Flashcards

1
Q

what are the different types of complications that can occur in surgery?

A
  • surgical
  • general
  • anaesthetic
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2
Q

what are the different time occurrences for post operative complications?

A
  • immediate= 1st 24 hrs
  • early= within the first 30 days
  • late= often after they have left the hospital
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3
Q

what are examples of immediate surgical complications?

A
  • haemorrhage
    damage to adjacent structures
  • complications of a specific operation
  • positional- l prone position has increased risk of injury of cervical spine and brachial plexus
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4
Q

what are immediate anaesthetic complications?

A
  • can’t intubate
  • can’t ventilate
  • aspiration
  • electrolyte disturbance
  • allergies
  • regional anaesthetic
  • complications
  • malignant hyperthermia
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5
Q

what are some issues that people can have with anaesthesia?

A
  • malignant hyperthermia
  • scoline/ suxamethonium apnoea
  • aspiration during anaesthesia due to delayed gastric emptying- can be due to diabetes
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6
Q

what are some immediate general complications that can arise during surgery?

A

cardiac dysrhythmias
myocardial ischaemia/infarction
hypothermia

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7
Q

what are some early respiratory complications that can occur as a result of surgery?

A
  • opiate overdose
  • pneumothorax
  • adult respiratory distress syndrome
    (ARDS)
  • collapse
  • atelectasis
  • infection
  • embolism
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8
Q

what time frames can early complications of surgery be broken down into?

A
  • primary
    at time of surgery
  • reactionary
    few hours after surgery
  • secondary
    5-10 days post surgery
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9
Q

what is the definition of shock?

A

hypoperfusion of tissues that is not adequate for basal requirements”

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10
Q

what are some causes of sepsis?

A
  • chest infection
  • central line
  • urine infection
  • wound infection
    abdomen / pelvis
  • C.difficile
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11
Q

how does a septic patient appear?

A
  • pulse >90 bpm
  • respiratory rate >20
  • temperature >38°C or <36°C
  • white cell count >12 or <4
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12
Q

what is a late surgical complication?

A

fibrosis, adhesions, keloids

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13
Q

what are the 4 different classifications of wound infection?

A
  1. clean >1% infection: uninfected operative wound with no inflammation, no organs opened
  2. clean contaminated >10%: organs opened but with little spillage
  3. contaminated 15-20%: obvious spillage/ inflammation e.g. gangrenous appendix
  4. dirty/ infected 40%- obvious gross contamination
    - gunshot wound
    - presence of puss
    - perforated large bowel
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14
Q

what are general risk factors for wound infection?

A
  • age
  • respiratory disease
  • smoking
  • diabetes (type I and II)
  • obesity
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15
Q

what are organ failures that can result in increased risk of wound infection?

A

organ failure

  • uraemia
  • obstructive jaundice
  • malignancy
  • malnutrition
  • steroids
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16
Q

what are local factors that can cause wound infection?

A 
faecal peritonitis
emergency cases
irradiated tissue
foreign body
lower midline incision
surgical technique
17
Q

what is wound dehiscence?

A

surgical incision reopens either internally or externally
- can occur 2days-3weeks after surgery
incidence 1.5%
mortality 25%

18
Q

when can paralytic illeus happen after surgery?

A

2nd day after- 3rd week

19
Q

what is the treatment for wound dehiscence?

A

ABCDE
moist sterile towels
antibiotics
urgent laparotomy - call seniors stat

20
Q

what is virchov’s triad for DVT?

A
  1. Stasis
    - length of operation
    - pelvic and hip injury
    - pregnancy
  2. endothelial trauma
    - IV drug use
    - previous DVT/PE
  3. hypercoagubaility
    - malignancy
    - OCP
    - family history
    thrombophilia- protein c or s deficiency
21
Q

what is the prophylaxis for DVT?

A
  • thrombo-embolic stockings (TEDs)
  • intra-operative compression
  • low molecular weight heparin (LMWH)
  • intravenous heparin
  • early mobilisation
22
Q

what are the 4 T reversible causes of cardiac arrest?

A

tension pneumothorax
- build-up of tension causes shifts that can rapidly lead to cardiovascular collapse and death. ECG signs include narrow QRS complexes and rapid heart rate

  • tamponade
    buildup of fluid results in the ineffective pumping of the blood which can lead to cardiac arrest

thromboembolism
- pulmonary embolism (PE) is a blockage of the main artery of the lung which can rapidly lead to respiratory collapse and sudden death

toxic
- cause pulseless arrest. include tricyclics, digoxin, beta-blockers, and calcium channel blockers.
Also Street drugs such as coccaine

23
Q

what are the 4 Hs that can cause reversible cardiac arrest?

A

hypoxia
hypovolaemia
hypothermia
hyper/hypokalaemia

24
Q

what are the symptoms of PE?

A

chest pain
shortness of breath
haemoptysis

25
Q

what are signs of PE?

A

tachypnoea
tachycardia
raised JVP
pleural rub

26
Q

what are investigations for PE?

A

blood gases
CXR
ECG
CTPA

27
Q

what is the treatment for PE?

A

O2
anticoagulation
thrombolysis
embolectomy

28
Q

how long should you anticoagulant after hip surgery?

A

28 days

  • LMWH 10 days then aspirin 75-150 mg for further 28 days
  • LMWH for 28 days with stockings
  • or rivaraxaban
29
Q

how long should you anticiagulate for knee surgery?

A

14 days

  • aspirin 14 days
  • LMWH and stockings for 14 days
  • rivaroxaban
30
Q

how long should you anticoagnula

A

LMWH

continue until reach normal mobility

31
Q

what is the treatment for malignant hyperthermia?

A

IV dantrolene therapy

32
Q

when is suxamethonium contraindicated?

A

for patients with penetrating eye injuries or acute narrow angle glaucoma, as suxamethonium increases intra-ocular pressure

33
Q

what is suxamthonium apnea?

A

Pseudocholinesterase deficiency:
the effects of suxamethonium are prolonged and the patient needs to be mechanically ventilated and observed in ITU until the effects of suxamethonium wear off.

34
Q

what are risk factors for urinary retention?

A
  • removal of urinary catheter,
  • constipation,
  • immobility,
  • opiate analgesia,
  • infection,
  • haematuria
  • benign prostatic hyperplasia
35
Q

what is local anaesthetic toxicity treated with?

A

with IV 20% lipid emulsion

36
Q

what can cause hypothermia in surgery?

A
  • Administration of unwarmed intravenous fluids, inhalation gases or irrigation of body cavities
  • Exposure to cold theatre environment
  • Use of cool skin preparation fluids
  • Use muscle relaxants prevents shivering
  • Spinal or epidural anaesthesia prevents peripheral vasoconstriction via reduced sympathetic tone. This causes increased heat loss at the peripheries
37
Q

what are the consequences of hypothermia

A

anaesthetic drugs are metabolised more slowly and platelet, coagulation factors and the immune system are less effective.
 This may cause excessive bleeding

38
Q

what 5 elements of monitoring are essential with parenteral nutrition?

A
  • blood glucose
  • 4hrly temperature and observations
  • daily electrolytes
  • daily inspection of line and dressing
  • accurate fluid level recording
39
Q

what is a normal radiological finding after surgery of the abdomen?

A

air under the semi-diaphram

surgery (10 decks)

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