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Elaina: Surgery > Post-op complications > Flashcards

Post-op complications Flashcards

1
Q

at what temperature is a fever worthy of investigation?

A

38 C (100.4 F)

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2
Q

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

A

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

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3
Q

what percentage of general anesthesia patients experience atelectasis?

A

90 percent

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4
Q

what are two ways in which we can prevent atelectasis?

A

1) incentive spirometry

2) mobility

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5
Q

what is the prognosis for atelectasis?

A

usually resolves within 48 hours

pneumonia after 72 hours

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6
Q

on what day does post-op atelectasis typically present?

A

post op day 1-2

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7
Q

absorptive atelectasis will present how?

A

pain with deep inspiration

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8
Q

what are two ways in which atelectasis most often occurs?

A

anesthesia, ventilator associated

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9
Q

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

A

water = UTI

POD 3-5

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10
Q

what is the most common reason for UTI following surgery?

A

foley catheter is frequently still in place

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11
Q

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

A

pelvic, general, orthopedic

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12
Q

BEST prophylaxis for DVT?

A

walk the patient on POD 1!

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13
Q

what are two types of mechanical PPX for DVT?

A

1) pneumatic compression

2) antiembolism stockings

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14
Q

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

A

heparin/LMWH, warfarin, aspirin

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15
Q

how soon following surgery do infections typically present?

A

POD 5-7

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16
Q

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

A

wonder drugs

drugs can cause fevers

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17
Q

alveolar hypoventilation is caused by what conditions? (4)

A

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

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18
Q

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

A

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

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19
Q

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

A

1) ambulation
2) cough
3) incentive spirometry

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20
Q

how can we treat post-op pneumonia?

A

chest physiotherapy, antibiotics

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21
Q

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

A

pathogens that can cause ventilator associated pneumonitis

22
Q

what are common pathogens seen in ventilator associated pneumonitis?

A

gram negative pseudomonas, serratia

gram positive possibly MRSA

23
Q

how do we prevent ventilator associated pneumonitis? (2)

A

1) aseptic technique

2) avoid prolonged intubation

24
Q

how do we treat ventilator associated pneumonitis?

A

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

antibiotics

25
Q

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

A

d-dimer (elevated in all individuals after surgery)

26
Q

how should we diagnose DVT in our patient following surgery?

A

doppler ultrasound

27
Q

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

A

pulmonary embolism

28
Q

how do we diagnose PE?

A

chest CT angiogram

VQ scan

29
Q

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

A

no!

stick with heparin/LMWH, heparin

30
Q

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

A

nope

31
Q

what are 5 consequences of arrhythmia?

A

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

32
Q

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

A

24 hours

33
Q

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

A

reverse cause! frequently resolve when cause is reversed

34
Q

should we consider a perioperative beta blockade to prevent arrhythmia?

A

NO

mortality rate was shown to be higher in BB group than control group in study (though apparently a poor study)

35
Q

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

A

hypotension and stroke if given too much

36
Q

should a patient stop their beta blocker prior to surgery?

A

NO

if they are already on it, leave it

37
Q

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

A

myocardial infarction

38
Q

why is the rate of MI so high following surgery?

A

stress = increased catecholamine release

lose blood = lose O2 carrying capacity

39
Q

when does MI typically occur following surgery?

A

MC 48 hours after surgery, most within 5 days

40
Q

how might MI present follow surgery?

A

usually doesn’t present with typical CP

may have unexplained SOB, HF, tachycardia, hypotension

41
Q

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

A

consult with surgeon/cardiology

42
Q

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

A

heart failure/pulmonary edema

43
Q

how will a patient with pulmonary edema typically present?

A

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

44
Q

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

A

increased vascular markings (cephalization of vessels

45
Q

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

A

increased vascular markings (cephalization of vessels towards apex)

46
Q

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

A

digoxin

47
Q

do diuretics reduce preload or afterload?

A

reduce preload!

give in HF/pulmonary edema

48
Q

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

A

less than 40 percent

49
Q

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

A

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

50
Q

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

A

double or triple valve replacement

51
Q

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

A

1) AVOID aggressive BB

2) give statins!

52
Q

3 TX options should stroke occur?

A

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

Elaina: Surgery (6 decks)

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