post op assessment Flashcards
what are the different types of complications that can occur in surgery?
- surgical
- general
- anaesthetic
what are the different time occurrences for post operative complications?
- immediate= 1st 24 hrs
- early= within the first 30 days
- late= often after they have left the hospital
what are examples of immediate surgical complications?
- 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
what are immediate anaesthetic complications?
- can’t intubate
- can’t ventilate
- aspiration
- electrolyte disturbance
- allergies
- regional anaesthetic
- complications
- malignant hyperthermia
what are some issues that people can have with anaesthesia?
- malignant hyperthermia
- scoline/ suxamethonium apnoea
- aspiration during anaesthesia due to delayed gastric emptying- can be due to diabetes
what are some immediate general complications that can arise during surgery?
cardiac dysrhythmias
myocardial ischaemia/infarction
hypothermia
what are some early respiratory complications that can occur as a result of surgery?
- opiate overdose
- pneumothorax
- adult respiratory distress syndrome
(ARDS) - collapse
- atelectasis
- infection
- embolism
what time frames can early complications of surgery be broken down into?
- primary
at time of surgery - reactionary
few hours after surgery - secondary
5-10 days post surgery
what is the definition of shock?
hypoperfusion of tissues that is not adequate for basal requirements”
what are some causes of sepsis?
- chest infection
- central line
- urine infection
- wound infection
abdomen / pelvis - C.difficile
how does a septic patient appear?
- pulse >90 bpm
- respiratory rate >20
- temperature >38°C or <36°C
- white cell count >12 or <4
what is a late surgical complication?
fibrosis, adhesions, keloids
what are the 4 different classifications of wound infection?
- clean >1% infection: uninfected operative wound with no inflammation, no organs opened
- clean contaminated >10%: organs opened but with little spillage
- contaminated 15-20%: obvious spillage/ inflammation e.g. gangrenous appendix
- dirty/ infected 40%- obvious gross contamination
- gunshot wound
- presence of puss
- perforated large bowel
what are general risk factors for wound infection?
- age
- respiratory disease
- smoking
- diabetes (type I and II)
- obesity
what are organ failures that can result in increased risk of wound infection?
organ failure
- uraemia
- obstructive jaundice
- malignancy
- malnutrition
- steroids
what are local factors that can cause wound infection?
faecal peritonitis emergency cases irradiated tissue foreign body lower midline incision surgical technique
what is wound dehiscence?
surgical incision reopens either internally or externally
- can occur 2days-3weeks after surgery
incidence 1.5%
mortality 25%
when can paralytic illeus happen after surgery?
2nd day after- 3rd week
what is the treatment for wound dehiscence?
ABCDE
moist sterile towels
antibiotics
urgent laparotomy - call seniors stat
what is virchov’s triad for DVT?
- Stasis
- length of operation
- pelvic and hip injury
- pregnancy - endothelial trauma
- IV drug use
- previous DVT/PE - hypercoagubaility
- malignancy
- OCP
- family history
thrombophilia- protein c or s deficiency
what is the prophylaxis for DVT?
- thrombo-embolic stockings (TEDs)
- intra-operative compression
- low molecular weight heparin (LMWH)
- intravenous heparin
- early mobilisation
what are the 4 T reversible causes of cardiac arrest?
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
what are the 4 Hs that can cause reversible cardiac arrest?
hypoxia
hypovolaemia
hypothermia
hyper/hypokalaemia
what are the symptoms of PE?
chest pain
shortness of breath
haemoptysis
what are signs of PE?
tachypnoea
tachycardia
raised JVP
pleural rub
what are investigations for PE?
blood gases
CXR
ECG
CTPA
what is the treatment for PE?
O2
anticoagulation
thrombolysis
embolectomy
how long should you anticoagulant after hip surgery?
28 days
- LMWH 10 days then aspirin 75-150 mg for further 28 days
- LMWH for 28 days with stockings
- or rivaraxaban
how long should you anticiagulate for knee surgery?
14 days
- aspirin 14 days
- LMWH and stockings for 14 days
- rivaroxaban
how long should you anticoagnula
LMWH
continue until reach normal mobility
what is the treatment for malignant hyperthermia?
IV dantrolene therapy
when is suxamethonium contraindicated?
for patients with penetrating eye injuries or acute narrow angle glaucoma, as suxamethonium increases intra-ocular pressure
what is suxamthonium apnea?
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.
what are risk factors for urinary retention?
- removal of urinary catheter,
- constipation,
- immobility,
- opiate analgesia,
- infection,
- haematuria
- benign prostatic hyperplasia
what is local anaesthetic toxicity treated with?
with IV 20% lipid emulsion
what can cause hypothermia in surgery?
- 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
what are the consequences of hypothermia
anaesthetic drugs are metabolised more slowly and platelet, coagulation factors and the immune system are less effective.
This may cause excessive bleeding
what 5 elements of monitoring are essential with parenteral nutrition?
- blood glucose
- 4hrly temperature and observations
- daily electrolytes
- daily inspection of line and dressing
- accurate fluid level recording
what is a normal radiological finding after surgery of the abdomen?
air under the semi-diaphram
