Post Op Complications

Question 1

What is delirium ?

Answer 1

An acute confusional state characterised by a disturbed consciousness and reduced cognitive function.

Question 2

What are the types of delirium ?

Answer 2

Hypoactive - lethargy and reduced motor function
Hyperactive - agitated and increased motor function

Question 3

What are the common causes of delirium ?

Answer 3

Hypoxia
Infection - UTI or LRTI
Drug induced
Dehydration or pain
Constipation or urinary retention

Question 4

What are the key features to assess in delirium ?

Answer 4

Onset and course of confusion
Symptoms of possible course
Previous episodes
Drug history

Question 5

What are some investigations to perform when suspecting delirium ?

Answer 5

Urinalysis
Bloods - FBC, U&E’s, calcium and glucose
Blood cultures and wound swabs
CXR
CT head only if relevant

Question 6

What is the management of delirium ?

Answer 6

Treat cause - ABX, oxygen or laxatives
Encourage oral fluid intake
Provide analgesia
Monitor bowels and urinary output
Sedatives if necessary - Haloperidol

Question 7

What are some clinical features of haemorrhagic shock ?

Answer 7

Tachycardia
Dizziness
Agitation
Raised RR
Decreased urine output
Swelling
Peritonism
Tenderness

Question 8

What is the management for post-operative bleeding ?

Answer 8

A to E
Rapid fluid resus
Urgent blood transfusion
Re-operate

Question 9

What are some appropriate investigations to determine the cause of sepsis ?

Answer 9

Urine dip
CXR
Swabs of surgical wound
LP
Stool culture

Question 10

What are the common sources of pyrexia in a a surgical patient ?

Answer 10

Chest (infection )
Cut ( wound infection )
Catheter ( UTI )
Collections ( abdomen and pelvis )
Calves ( DVT )
Cannula ( infection)
Central line ( infection )

Question 11

What is shock ?

Answer 11

A severe drop in BP that causes a dangerous reduction of blood flow throughout the body

Question 12

What can cause shock ?

Answer 12

Blood loss
Infection
Brain injury
Metabolic problems

Question 13

What is the management of shock ?

Answer 13

Stop blood loss - surgery
Assist with breathing - provide oxygen
Give IV fluids
Blood transfusion

Question 14

What is a wound infection ?

Answer 14

When bacteria enter the site of surgery causing an infection. Infections can delay wound healing. Wound infections can spread to nearby organs and tissues.

Question 15

What is the management of wound infections ?

Answer 15

ABx
Surgery - debridement

Question 16

What is a DVT ?

Answer 16

A blood clot forms in a large deep vein in the leg causing pain, swelling and redness.

Question 17

What is a PE ?

Answer 17

A clot can dislodge and travel to the lungs. This can obstruct blood supply to the lungs.

Question 18

What are some symptoms of PE ?

Answer 18

Chest pain
Trouble breathing
Coughing - haemoptysis
Sweating
Tachycardia

Question 19

What is the management for a PE ?

Answer 19

Oxygen
Fluids
Anticoagulants
Thrombolysis

Question 20

Why is urinary retention a post op complication and treatment ?

Answer 20

It can be caused by the anaesthetic
Usually treated by inserting a catheter

Question 21

If someone presents with delirium what should be asked about to determine cause ?

Answer 21

Fever
LUTS
Passing urine
Dehydration
Pain
Constipation

Question 22

If someone presents with delirium what examinations should be performed ?

Answer 22

Check for haemodynamic instability
Examine the surgical wound site to check for dehiscence
Neurological exam - assess fro deficits
GI exam - feeling for constipation or peritonism
Resp exam - listen for crackles, wheeze
Assess fluid status for dehydration

Question 23

What examinations would you do if suspecting wound dehiscence ?

Answer 23

Check for haemodynamic instability
Examine surgical site for infection or dehiscence
GI exam - inspect wound and palpate for any peritonism

Question 24

What are some risk factors for wound dehiscence ?

Answer 24

Vitamin C deficiency
Obesity
Smoking
Steroids

Question 25

What is the management of wound dehiscence ?

Answer 25

IV abx to reduce risk of infection
Call surgical team to return to theatre

Question 26

What examinations would you do if you suspect cellulitis after surgery ?

Answer 26

Check for haemodynamic instability
Exam the leg - rash, swelling, colour change and temp
Neurovascular exam
Cardiovascular exam
Resp exam - RR, air entry

Question 27

What is the management of cellulitis post surgery ?

Answer 27

Mark border
Analgesia
Elevation
Antipyretics
Oral flucloxacillin
Consider MRSA cover

Question 28

What examinations would you do when suspecting a DVT post surgery ?

Answer 28

Check for haemodynamic instability
Exam the leg - rash, swelling, colour change and temp
Neurovascular exam
Cardiovascular exam
Resp exam - RR, air entry

Question 29

What is another differential for a DVT ?

Answer 29

Compartment syndrome

Question 30

What is the management of a DVT ?

Answer 30

Apixaban fro 3 months

Question 31

What examinations would you do when suspecting compartment syndrome after surgery ?

Answer 31

Observations to check for haemodynamic instability
Examine leg - rash, swelling, colour, temp
Neurovascular exam - temp, pulses, distal sensation

Question 32

What examinations should you do when someone presents with abdominal post surgery ?

Answer 32

Observations to check for haemodynamic instability
Examination of the surgical wound site to check for dehiscence and infection
Gastrointestinal examination: inspecting the wound, palpating for potential peritonism, percussing for free fluid (blood) accumulated in the abdomen.

Question 33

What are 2 risk factors for an anastomotic leak ?

Answer 33

Poor surgical technique
No stoma so no defunctioning

Question 34

How to manage an anastomotic leak after surgery ?

Answer 34

A to e and resus
Keep NBM and place an NG tube
Catheter
Analgesia and antiemetics