Post Op Complications Flashcards
What is delirium ?
An acute confusional state characterised by a disturbed consciousness and reduced cognitive function.
What are the types of delirium ?
Hypoactive - lethargy and reduced motor function
Hyperactive - agitated and increased motor function
What are the common causes of delirium ?
Hypoxia
Infection - UTI or LRTI
Drug induced
Dehydration or pain
Constipation or urinary retention
What are the key features to assess in delirium ?
Onset and course of confusion
Symptoms of possible course
Previous episodes
Drug history
What are some investigations to perform when suspecting delirium ?
Urinalysis
Bloods - FBC, U&E’s, calcium and glucose
Blood cultures and wound swabs
CXR
CT head only if relevant
What is the management of delirium ?
Treat cause - ABX, oxygen or laxatives
Encourage oral fluid intake
Provide analgesia
Monitor bowels and urinary output
Sedatives if necessary - Haloperidol
What are some clinical features of haemorrhagic shock ?
Tachycardia
Dizziness
Agitation
Raised RR
Decreased urine output
Swelling
Peritonism
Tenderness
What is the management for post-operative bleeding ?
A to E
Rapid fluid resus
Urgent blood transfusion
Re-operate
What are some appropriate investigations to determine the cause of sepsis ?
Urine dip
CXR
Swabs of surgical wound
LP
Stool culture
What are the common sources of pyrexia in a a surgical patient ?
Chest (infection )
Cut ( wound infection )
Catheter ( UTI )
Collections ( abdomen and pelvis )
Calves ( DVT )
Cannula ( infection)
Central line ( infection )
What is shock ?
A severe drop in BP that causes a dangerous reduction of blood flow throughout the body
What can cause shock ?
Blood loss
Infection
Brain injury
Metabolic problems
What is the management of shock ?
Stop blood loss - surgery
Assist with breathing - provide oxygen
Give IV fluids
Blood transfusion
What is a wound infection ?
When bacteria enter the site of surgery causing an infection. Infections can delay wound healing. Wound infections can spread to nearby organs and tissues.
What is the management of wound infections ?
ABx
Surgery - debridement
What is a DVT ?
A blood clot forms in a large deep vein in the leg causing pain, swelling and redness.
What is a PE ?
A clot can dislodge and travel to the lungs. This can obstruct blood supply to the lungs.
What are some symptoms of PE ?
Chest pain
Trouble breathing
Coughing - haemoptysis
Sweating
Tachycardia
What is the management for a PE ?
Oxygen
Fluids
Anticoagulants
Thrombolysis
Why is urinary retention a post op complication and treatment ?
It can be caused by the anaesthetic
Usually treated by inserting a catheter
If someone presents with delirium what should be asked about to determine cause ?
Fever
LUTS
Passing urine
Dehydration
Pain
Constipation
If someone presents with delirium what examinations should be performed ?
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
What examinations would you do if suspecting wound dehiscence ?
Check for haemodynamic instability
Examine surgical site for infection or dehiscence
GI exam - inspect wound and palpate for any peritonism
What are some risk factors for wound dehiscence ?
Vitamin C deficiency
Obesity
Smoking
Steroids
What is the management of wound dehiscence ?
IV abx to reduce risk of infection
Call surgical team to return to theatre
What examinations would you do if you suspect cellulitis after surgery ?
Check for haemodynamic instability
Exam the leg - rash, swelling, colour change and temp
Neurovascular exam
Cardiovascular exam
Resp exam - RR, air entry
What is the management of cellulitis post surgery ?
Mark border
Analgesia
Elevation
Antipyretics
Oral flucloxacillin
Consider MRSA cover
What examinations would you do when suspecting a DVT post surgery ?
Check for haemodynamic instability
Exam the leg - rash, swelling, colour change and temp
Neurovascular exam
Cardiovascular exam
Resp exam - RR, air entry
What is another differential for a DVT ?
Compartment syndrome
What is the management of a DVT ?
Apixaban fro 3 months
What examinations would you do when suspecting compartment syndrome after surgery ?
Observations to check for haemodynamic instability
Examine leg - rash, swelling, colour, temp
Neurovascular exam - temp, pulses, distal sensation
What examinations should you do when someone presents with abdominal post surgery ?
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.
What are 2 risk factors for an anastomotic leak ?
Poor surgical technique
No stoma so no defunctioning
How to manage an anastomotic leak after surgery ?
A to e and resus
Keep NBM and place an NG tube
Catheter
Analgesia and antiemetics
