Post-Op Complications

Question 1

A temperature of ______ is worth an investigation.

Answer 1

38.0

Question 2

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

Answer 2

Wind, Water, Walking, Wound, Wonder drugs

Question 3

How many days after surgery does atelectasis typically present?

Answer 3

1-2

Question 4

After how many hours does pneumonia typically present?

Answer 4

72

Question 5

What 2 things can we do to prevent atelectasis?

Answer 5

Incentive spirometry and mobility

Question 6

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

Answer 6

Foley catheter

3-5 days

Question 7

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

Answer 7

Pelvic, general, and orthopedic surgery

Question 8

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

Answer 8

DVT

Question 9

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

Answer 9

4-6

Question 10

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

Answer 10

1. Atelectasis

2. Pulmonary edema

Question 11

Post-op pneumonia is frequently thought secondary to _______.

Answer 11

Atelectasis

Question 12

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

Answer 12

Pneumonia

Question 13

How can we prevent post-op pneumonia?

Answer 13

Ambulation, cough, and incentive spirometry

Question 14

How do you diagnose pneumonia?

Answer 14

Auscultate, CxR, and WBC

Question 15

What are common pathogens of ventilator associated pneumonia?

Answer 15

Gram (-): pseudomonas, serratia

gram (+): possibly MRSA

Question 16

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

Answer 16

Pulmonary embolism

Question 17

How do we diagnose a PE?

Answer 17

Chest CT angiogram

VQ Scan

Question 18

Arrhythmias are commonly associated with what type of surgery?

Answer 18

cardiac or thoracic surgery

Question 19

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

Answer 19

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

Question 20

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

Answer 20

Arrhythmias

Question 21

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

Answer 21

24

Question 22

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

Answer 22

MI

Question 23

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

Answer 23

Post op MI

Question 24

What are some signs of heart failure?

Answer 24

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

Question 25

How do we treat post op heart failure?

Answer 25

Diuretics

Question 26

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

Answer 26

Stroke

Question 27

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

Answer 27

Double or triple valve replacement

Question 28

What type of surgery has the lowest procedural risk?

Answer 28

General surgery

Question 29

How do we prevent perioperative stroke?

Answer 29

Avoidance of acute or aggressive beta blockers and STATINS

Question 30

How do we treat a postoperative stroke?

Answer 30

ASA, embolectomy, and intra-arterial tPA

Question 31

Acute mechanical failure of the wound closure

Answer 31

Dehiscence

Question 32

What are causes of dehiscence?

Answer 32

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

Question 33

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

Answer 33

14-16%

Question 34

What do most post-op wound infections require?

Answer 34

Surgical debridement

Question 35

What are some signs of wound infection?

Answer 35

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

Question 36

What are the four surgical classifications/wound infections?

Answer 36

1. Clean 2. Clean-contaminated 3. Contaminated 4. Dirty

Question 37

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

Answer 37

No gross contamination

Question 38

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

Answer 38

Lightly contaminated

Question 39

Does a dirty wound mean its infected?

Answer 39

Yep

Question 40

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

Answer 40

Elective GI surgeries

Question 41

Example of a contaminated wound?

Answer 41

Perforated gastric ulcer

Question 42

Example of a dirty wound?

Answer 42

Intestinal infarction, intra-abdominal abscess drainage

Question 43

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

Answer 43

Polymicrobial -- frequently gram negative

Question 44

how can we prevent a contaminated wound infection?

Answer 44

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

Question 45

What is the source of a dirt wound infection?

Answer 45

established post-op infection

Question 46

C. diff is associated with _______ use.

Answer 46

antibiotic

Question 47

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

Answer 47

Clindamycin and FQ's

Question 48

True or False Hand sanitizer will kill C. diff no problem

Answer 48

FALSE WASH DEM HANDS

Question 49

How do we treat C. Diff?

Answer 49

PO Metronidazole PO Vanco PO Vanco PLUS IV metro

Question 50

What is the most frequently acquired nosocomial infection?

Answer 50

UTI

Question 51

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

Answer 51

UTIs

Question 52

Dysuria and mild fever, think?

Answer 52

Cystitis

Question 53

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

Answer 53

Pyelonephritis

Question 54

How can we prevent UTI's?

Answer 54

Get the catheter out ASAP

Question 55

How do we treat UTIs?

Answer 55

Hydration, bladder drainage, specific antibiotics

Question 56

Temporary paralysis of a portion of the bowels

Answer 56

Post operative ileus

Question 57

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

Answer 57

Post Operative ileus

Question 58

How do we diagnose a post operative ileus?

Answer 58

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

Question 59

How do we treat a post operative ileus?

Answer 59

NPO, NG tube, IVF/Nutrition

Question 60

What are some triggers of malignant hyperthermia?

Answer 60

Extreme stress and anesthetic agents

Question 61

What are some signs of malignant hyperthermia?

Answer 61

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

Question 62

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

Answer 62

Malignant hyperthermia

Question 63

How do we treat malignant hyperthermia?

Answer 63

Discontinue the triggering agent and dantroline -- and other stuff

Question 64

What are the 6 abberancies that were mentioned in lecture?

Answer 64

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