Post-op complications Flashcards by Elaina Collins

at what temperature is a fever worthy of investigation?

38 C (100.4 F)

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what are the 5 W’s for causes of fever following surgery?

1) wind
2) water
3) walking
4) wound
5) wonder drugs or wombs in OB/GYN

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what percentage of general anesthesia patients experience atelectasis?

90 percent

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what are two ways in which we can prevent atelectasis?

1) incentive spirometry

2) mobility

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what is the prognosis for atelectasis?

usually resolves within 48 hours

pneumonia after 72 hours

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on what day does post-op atelectasis typically present?

post op day 1-2

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absorptive atelectasis will present how?

pain with deep inspiration

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what are two ways in which atelectasis most often occurs?

anesthesia, ventilator associated

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what do we really mean by water in terms of the 2nd W of fever? on what day post op does this present?

water = UTI

POD 3-5

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what is the most common reason for UTI following surgery?

foley catheter is frequently still in place

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in what types of surgery do we most frequently encounter DVT post-op?

pelvic, general, orthopedic

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BEST prophylaxis for DVT?

walk the patient on POD 1!

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what are two types of mechanical PPX for DVT?

1) pneumatic compression

2) antiembolism stockings

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what are the 3 drugs we can give to PPX for DVT?

heparin/LMWH, warfarin, aspirin

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how soon following surgery do infections typically present?

POD 5-7

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which “W” in the 5 W’s of fever typically occurs 7+ days out?

wonder drugs

drugs can cause fevers

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alveolar hypoventilation is caused by what conditions? (4)

1) pain
2) CNS depression
3) body habitus
4) OSA

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in what populations should we always be on the lookout for aspiration following surgery?

1) gastric distension
2) mental status issues
3) head injuries (trauma cases)
4) elderly

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how can we prevent post-op pneumonia? (3)

1) ambulation
2) cough
3) incentive spirometry

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how can we treat post-op pneumonia?

chest physiotherapy, antibiotics

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an ET tube or ventilator tube can act as reservoirs for what?

pathogens that can cause ventilator associated pneumonitis

what are common pathogens seen in ventilator associated pneumonitis?

gram negative pseudomonas, serratia

gram positive possibly MRSA

how do we prevent ventilator associated pneumonitis? (2)

1) aseptic technique

2) avoid prolonged intubation

how do we treat ventilator associated pneumonitis?

support (ventilatory, fluid/vascular, suction with culture)

antibiotics

what test will be useless in our patient who we suspect is developing a DVT post op?

d-dimer (elevated in all individuals after surgery)

how should we diagnose DVT in our patient following surgery?

doppler ultrasound

sudden SOB, pleuritic CP, fever, hypoxemia, tachycardia, hemoptysis

pulmonary embolism

how do we diagnose PE?

chest CT angiogram VQ scan

do novel oral anticoagulants have a role in post-op DVT treatment yet?

no! stick with heparin/LMWH, heparin

should we attempt TPA following surgery in our patient with a PE?

nope

what are 5 consequences of arrhythmia?

1) stroke 2) heart failure (backup bc heart not efficient pump) 3) ischemia 4) prolonged ICU/hospital stay 5) death

in terms of a fib, after how long must we anticoagulate before considering cardioversion?

24 hours

what is the best way to treat post-op arrhythmia?

reverse cause! frequently resolve when cause is reversed

should we consider a perioperative beta blockade to prevent arrhythmia?

NO mortality rate was shown to be higher in BB group than control group in study (though apparently a poor study)

beta blockers have the possibility of causing what, that could lead to mortality if given pre-operatively?

hypotension and stroke if given too much

should a patient stop their beta blocker prior to surgery?

NO if they are already on it, leave it

what is the most common cause of morbidity and mortality following non-cardiac surgery?

myocardial infarction

why is the rate of MI so high following surgery?

stress = increased catecholamine release lose blood = lose O2 carrying capacity

when does MI typically occur following surgery?

MC 48 hours after surgery, most within 5 days

how might MI present follow surgery?

usually doesn't present with typical CP may have unexplained SOB, HF, tachycardia, hypotension

what should you do if your post-op patient is having an MI?

consult with surgeon/cardiology

fluid overload, post op MI, and arrhythmias with a high ventricular rate all put a patient at risk for what?

heart failure/pulmonary edema

how will a patient with pulmonary edema typically present?

dyspnea, hypoxemia (O2 can't freely flow bc of all the fluid)

what will we see on chest xray of a patient with pulmonary edema?

increased vascular markings (cephalization of vessels

what will we see on chest xray of a patient with pulmonary edema?

increased vascular markings (cephalization of vessels towards apex)

if we want to reduce the rate of an arrhythmia WITHOUT decreasing cardiac output, what is our drug of choice?

digoxin

do diuretics reduce preload or afterload?

reduce preload! give in HF/pulmonary edema

an ejection fraction less than what puts you at risk for perioperative stroke?

less than 40 percent

what 7 risk factors put you at risk for perioperative stroke?

1) advanced age 2) non-elective surgery 3) female sex 4) EF less than 40 5) vascular disease 6) DM 7) creatinine greater than 2 or dialysis

what type of procedure carries the greatest risk of stroke (nearing 10 percent)?

double or triple valve replacement

what are two ways in which we can prevent stroke perioperatively?

1) AVOID aggressive BB | 2) give statins!

3 TX options should stroke occur?

1) ASA 2) embolectomy 3) intra-arterial TPA