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Surgery > Post-Op Complications > Flashcards

Post-Op Complications Flashcards

1
Q

3 possible complications of pain

A

Atelectasis
Delirium
SIADH

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2
Q

Intra-operatively pt begins to have Early signs
Tachycardia, Cyanosis, Rigidity and an elevated body temperature +/- arrhythmia or other signs of organ dmg. Next best step in management.

A

Malignant Hyperthermia

  1. Discontinuation triggering agent (Anesthesia)
  2. Administer Dantrolene (ryanodine receptor antagonist)
  3. Cooling measures (Cold Blankets, Ice packs, etc.)
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3
Q

Patient begins to have fevers and chills within an hour of an invasive procedure. Next best step in management.

A

Bacteremia

  1. Blood Cultures
  2. Empiric Abxs
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4
Q

Patient begins to have fevers and extreme pain within hours after surgery? What is the worst possible thing that could be happening?

A

Gas Gangrene in the surgical wound

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5
Q

Post op fever (usually from 101º – 103ºF) is caused sequentially in time by (7):

A 
Atelectasis (POD# 1–2)
Pneumonia (POD# 1–3)
UTI (POD# 3–5)
Deep Vein Thrombophlebitis (POD#  5+)
Infection: Cellulitis  (POD# 7+)
Abscess (POD# 8+)
Drug Reaction (POD# 8+)
(A PUDICAD)
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6
Q

2 causes of Post-Op chest pain:

A

MI (POD# 2–3)

PE (POD# 7+)

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7
Q

Is a risk in awake intubations in combative patients or elderly with impaired swallowing/neurocognitive disorders.

A

Aspiration PNA

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8
Q

Management of Aspiration pneumonia includes

A

Bronchoscopy to remove debri and lavage
+/- bronchodilators & O2 treatment
—————
Prevent via NPO +/- PPIs

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9
Q

Intra-Op Tension Pneumothorax usually 2/2

A

Pt with recent blunt trauma to lungs or broken ribs put on PPV

(become harder to bag, BP steadily declines)

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10
Q

Most common cause of post-op delirium?

A

Hypoxia
(give O2 & get an ABG)
*may be 2/2 sepsis so r/o

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11
Q

Causes of Post-Op Altered Mental Status

7

A 
Hypoxia (POD# 1) 
ARDS (POD# 1–2)
Delirium Tremens (POD# 2–3) 
Hyponatremia 
Hypernatremia 
Ammonemia
Hypercarbia → COPDers
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12
Q

4 causes of decreased post-op Urine Output

A
  1. Urinary retention → (elderly, h/o BPH)
  2. Kinked/clotted catheter → ZERO UOP since surgery
  3. Dehydration → less than 0.5 ml/kg/hr of UOP
  4. Acute Renal Failure → low UOP
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13
Q

3 causes of post-op Abdominal Distention

A

Paralytic Ileus → Anesthesia
Adhesions → Bowel Obstruction
Ogilvie (pseudo obstruction) → Dilated Colon

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14
Q

4 Post- op wound or infection complications:

A

Wound

  1. Dehiscence
  2. Evisceration

Infection

  1. GI Fistulas → contaminating leaks
  2. Cellulitis of sx incision
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15
Q

TPN must be initiated after ____ of failed enteral nutrition.

TPN is initiated automatically in cases of severe
___ or ___

A

2–3 days (no longer than 1 week)

Burns or Brain Injury

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16
Q

Management of post-op Atelectasis (3)

——

A
  1. get CXR
  2. Improve Ventilation (postural drainage, incentive spirometry)
  3. Bronchoscopy (if no improvement)
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17
Q

Management of post-op Pneumonia (3)

A
  1. CXR
  2. Sputum Culture
  3. ABxs (Vanc & Pip-Tazo)
18
Q

Management of post-op UTI (2)

A
  1. UA (+/- urine culture)
  2. ## AntibioticsUncomplicated lower UTI
    Nitrofurantoin, TMP/SMX, Fosfomycin

Complicated lower UTIs (Men, anatomic d/o, kids)
Ciprofloxacin (Floroquinolone)

Men → Ciprofloxacin or TMP/SMX

19
Q

Management of post-op Thrombophlebitis (3)

IV site infection

A
  1. Replace IV
  2. Doppler imaging
  3. Heparin bridge → Warfarin
20
Q

Management of post-op Cellulitis Infection (3)

red/warm/painful skin

A
  1. Antibiotics (if it’s cellulitis)
  2. U/S (if it could be an abscess)
  3. I&D (if it’s an abscess)
21
Q

Management of post-op Deep Abscess (2)

A
  1. CT imaging

2. Percutaneous Drain (radiographically guided)

22
Q

Management of post-op MI (2)

A
  1. Get ECG & Troponin

2. Angioplasty or Stents (if needed)

23
Q

Management of post-op Pulmonary Embolism (2)

tachy+ diaphoretic + pleuritic pain + anxious +JVD

A
  1. Start Heparin
  2. add IVC filter (if PE recurs or AC is c/i)
  3. CTA confirms dx
Contraindications to Heparin/Warfarin → 
Active bleeding
recent Stoke/TIA
cranial trauma
recent neurosurgery
h/o HIT 
bleeding d/o
24
Q

Management of post-op AMS 2/2 Hypoxia (2)

A
  1. O2 supplementation

2. ABG

25
Q

Management of post-op AMS 2/2 ARDS (1)

A

PEEP

keep TV low to avoid barotrauma

26
Q

Management of post-op AMS 2/2 Delerium Tremens (1)

Pt is hallucinating + combative

A

Benzodiazepines

27
Q

Management of post-op AMS 2/2 Hyponatremia (1)

A

Hypertonic NaCl aliquots to D5W saline

(+/- osmotic diuretics to PREVENT)

Hyponatremia → rapid drop of Na+ in hrs → s/t excess D5W post-op + stress induced SIADH

28
Q

Post op pt day 1 presents with AMS.
Notably larger volume UOP.

Diagnosis and management?

A

½ D5W
or
⅓ D5W + NS

(AMS 2/2 Hypernatremia)

Hypernatremia → large UOP → tx with ½ D5W or ⅓ D5W + NS

29
Q

6hrs Post-op patient with urge to urinate, but is unable to what is the next best step in management?

A

Urinary retention:
In-Out Catheter (indicated if pt can’t pee after 6hrs)

→ Foley placement after 2-3 cath attempts and no spontaneous urine

30
Q

KUB shows dilated bowel w/ air-fluid level

Diagnosis:

A

Bowel Obstruction

31
Q

Ogilvie (pseudo obstruction) → dilated colon in elderly patient seen on KUB →
next step is to ____ →
then ___ & ____ placement
→ avoid _____ if possible
(b/c it is fatal if not Pseudo obstruction)

A

Replete fluids and electrolytes

Colonoscopy + Rectal tube placement

Neostigmine (AchE inhibitor)

32
Q

Ogilvie (pseudo obstruction) → dilated colon in elderly patient seen on KUB →
next step is to ____ →
then ___ & ____ placement
→ avoid _____ if possible
(b/c it is fatal if not Pseudo obstruction)

A

Replete fluids and electrolytes

Colonoscopy + Rectal tube placement

Neostigmine (AchE inhibitor)

33
Q

Dehiscence → skin closes, but fascia fails to close →

Next best step in management?

A

Abdominal Binder

while waiting to see if OR is needed

34
Q

Evisceration → s/t dehiscence → bowel spills out of incision
Next best step in management?

A
  1. Cover bowel in warm saline wraps a

2. Emergent OR

35
Q

GI Fistulas → Gastric fluids leak out of incision or drain
Next best step in management?

If free draining (afebrile, no peritonitis) (3)
If not freely draining (fever, peritonitis) (1)

A

If free draining (afebrile, no peritonitis):
1. IVFs & electrolyte replacement
2. nutritional support distal to fistula
3. suctions/–ostomy bags to protect abd wall
Fistula will heal naturally in time

If not freely draining (fever, peritonitis)
1. Complete drainage is required to prevent sepsis

36
Q

Patient has had ZERO urine output since surgery or has had urine output which suddenly has ceased. Next best step in management?

A

check catheter’s patency

it might be kinked or clotted

37
Q

Post-op patient has had a low urinary output ( <0.5 ml/kg/hr) what are 2 possible explanations?

(besides clotted catheter)

A

dehydration or acute renal failure

38
Q

In a post-op patient with low urinary output ( <0.5 ml/kg/hr) how can you differentiate between dehydration or acute renal failure as the primary etiology?

A
  1. Bolus 500ml IVF over 10m (H2O challenge) → if ↑UOP → dehydration
  2. After H20 challenge there is no appreciable change in UOP get urinary labs →

–FeNa<1% → dehydration
–FeNA >1% → acute renal failure

39
Q 
Post-Op Complications (list as many as you can)
Skin (6)
Vascular (3)
General (2)
GI (6)
Cardiac (2)
Pulm (4)
Renal (3)
A

Seromas, Site Infections, Dehiscence/Evisceration, pressure ulcers, Hernias (late)
Hemorrhage, Hematomas, DVTs
illeus, N/V, SBOs (s/t adhesions), leaks, fistulas
MIs, Arrhythmias (A-fib)
atelectasis, ARDS, PNA, PE
AKI, urinary retention, UTI (s/t catheter)

40
Q

Immediate or w/in hours causes of post-op fevers (3)

A

Febrile transfusion reaction
malignant hyperthermia
neuroleptic malignant synd (anti-emetics)

41
Q

Risk factors for Post-Op urinary retention (5-7)

A

old, male, BPH, diabetes, neurological condition, opioids, anticholinergics

Surgery (36 decks)

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