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Sam: Surgery > Post-Op Complications > Flashcards

Post-Op Complications Flashcards

1
Q

A temperature of ______ is worth an investigation.

A

38.0

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2
Q

What are the five “W’s” for cause of fever?

A

Wind, Water, Walking, Wound, Wonder drugs

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3
Q

How many days after surgery does atelectasis typically present?

A

1-2

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4
Q

After how many hours does pneumonia typically present?

A

72

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5
Q

What 2 things can we do to prevent atelectasis?

A

Incentive spirometry and mobility

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6
Q

What is a frequent cause of UTI’s post-op and how many days after surgery does it usually present?

A

Foley catheter

3-5 days

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7
Q

DVT’s are more common in patients who have had what types of surgery?

A

Pelvic, general, and orthopedic surgery

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8
Q

Walking the patient POD 1, pneumatic compression, antiembolism stockings, LMWH/UFH, warfarin, and aspirin are all prophylaxis for what?

A

DVT

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9
Q

How many days after surgery do DVT’s typically present?

A

4-6

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10
Q

What are two causes of respiratory failure (for the sake of this lecture)?

A
  1. Atelectasis

2. Pulmonary edema

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11
Q

Post-op pneumonia is frequently thought secondary to _______.

A

Atelectasis

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12
Q

What commonly presents with fever, SOB, gradual o2 desaturation, and cough?

A

Pneumonia

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13
Q

How can we prevent post-op pneumonia?

A

Ambulation, cough, and incentive spirometry

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14
Q

How do you diagnose pneumonia?

A

Auscultate, CxR, and WBC

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15
Q

What are common pathogens of ventilator associated pneumonia?

A

Gram (-): pseudomonas, serratia

gram (+): possibly MRSA

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16
Q

Sudden SOB, pleuritic chest pain, sudden hypoxemia, tachycardia, and cough/hemoptysis – think of?

A

Pulmonary embolism

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17
Q

How do we diagnose a PE?

A

Chest CT angiogram

VQ Scan

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18
Q

Arrhythmias are commonly associated with what type of surgery?

A

cardiac or thoracic surgery

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19
Q

What are some causes of post op arrhythmias (8)?

A
  1. Hypoxia
  2. Hypovolemia
  3. Hyperthermia
  4. Electrolyte imbalance
  5. Hypoglycemia
  6. HTN
  7. Infection
  8. Medications
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20
Q

Stroke, heart failure, ischemia, prolonged hospital stay, and death are all consequences of?

A

Arrhythmias

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21
Q

We want to anticoag after how many hours of a fib?

A

24

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22
Q

What is the most common cause of morbidity and mortality after non-cardiac surgery?

A

MI

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23
Q

Heart failure, unexplained SOB, tachycardia, hypotension, and +/- atypical chest pain are signs of?

A

Post op MI

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24
Q

What are some signs of heart failure?

A

Dyspnea, hypoxemia with normal CO2 tension, CxR with increased vascular markings

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25
Q

How do we treat post op heart failure?

A

Diuretics

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26
Q

Advanced age, non-elective surgery, female sex, EF less than 40 percent, vascular disease, DM, and increased creatinine are all risk factors for?

A

Stroke

27
Q

What type of surgery has the highest risk of perioperative stroke?

A

Double or triple valve replacement

28
Q

What type of surgery has the lowest procedural risk?

A

General surgery

29
Q

How do we prevent perioperative stroke?

A

Avoidance of acute or aggressive beta blockers and STATINS

30
Q

How do we treat a postoperative stroke?

A

ASA, embolectomy, and intra-arterial tPA

31
Q

Acute mechanical failure of the wound closure

A

Dehiscence

32
Q

What are causes of dehiscence?

A

Mechanical force, tissue ischemia due to tight suturing, poor suturing technique, local infection

33
Q

Post-op wound infections account for what percentage of infections in hospitalized patients?

A

14-16%

34
Q

What do most post-op wound infections require?

A

Surgical debridement

35
Q

What are some signs of wound infection?

A

Redness, swelling, localized heat and erythema, increase pain at incision site, dehiscence, tachycardia, fever (late)

36
Q

What are the four surgical classifications/wound infections?

A
  1. Clean
  2. Clean-contaminated
  3. Contaminated
  4. Dirty
37
Q

If you have a clean wound what does that mean in terms of classification?

A

No gross contamination

38
Q

Clean-contaminated wound is deemed what in terms of contamination?

A

Lightly contaminated

39
Q

Does a dirty wound mean its infected?

A

Yep

40
Q

What would be an example of a clean-contaminated wound?

A

Elective GI surgeries

41
Q

Example of a contaminated wound?

A

Perforated gastric ulcer

42
Q

Example of a dirty wound?

A

Intestinal infarction, intra-abdominal abscess drainage

43
Q

Are clean contaminated wound infections poly or monomicrobial? And is/are the bacteria(s) frequently gram positive or negative?

A

Polymicrobial – frequently gram negative

44
Q

how can we prevent a contaminated wound infection?

A

Antibiotics must be present at time of contamination and given pre op less than 60 minutes from time of incision

45
Q

What is the source of a dirt wound infection?

A

established post-op infection

46
Q

C. diff is associated with _______ use.

A

antibiotic

47
Q

What two antibiotics put people at risk for C. diff?

A

Clindamycin and FQ’s

48
Q

True or False

Hand sanitizer will kill C. diff no problem

A

FALSE

WASH DEM HANDS

49
Q

How do we treat C. Diff?

A

PO Metronidazole
PO Vanco
PO Vanco PLUS IV metro

50
Q

What is the most frequently acquired nosocomial infection?

A

UTI

51
Q

Pre-existing urinary tract contamination, urine retention, and instrumentation are all risk factors for?

A

UTIs

52
Q

Dysuria and mild fever, think?

A

Cystitis

53
Q

High fever, flank tenderness, occasionally ileus, think of?

A

Pyelonephritis

54
Q

How can we prevent UTI’s?

A

Get the catheter out ASAP

55
Q

How do we treat UTIs?

A

Hydration, bladder drainage, specific antibiotics

56
Q

Temporary paralysis of a portion of the bowels

A

Post operative ileus

57
Q

Nausea, vomiting, and vague abdominal discomfort are symptoms of?

A

Post Operative ileus

58
Q

How do we diagnose a post operative ileus?

A

Abdominal x-ray, clinical impression (quiet bowel sounds)

59
Q

How do we treat a post operative ileus?

A

NPO, NG tube, IVF/Nutrition

60
Q

What are some triggers of malignant hyperthermia?

A

Extreme stress and anesthetic agents

61
Q

What are some signs of malignant hyperthermia?

A

Abrupt increase in EtCO2, possible masseter rigidity, increased body temp, tachycardia, cyanosis, muscle rigidity

62
Q

Compartment syndromes, rhabdomyolysis, acidosis (metabolic and respiratory), arrhythmias/sudden cardiac arrest are all late effects of?

A

Malignant hyperthermia

63
Q

How do we treat malignant hyperthermia?

A

Discontinue the triggering agent and dantroline – and other stuff

64
Q

What are the 6 abberancies that were mentioned in lecture?

A
  1. Delirium
  2. Orthostasis
  3. Tachycardia
  4. Hyponatremia
  5. Atrial fibrillation
  6. Bradycardia

Sam: Surgery (5 decks)

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