Post op complications

Question 1

Causes of post op fever

Answer 1

• Day 1-2: atelectasis/pneumonia
• UTI: day 3-7
  
  • Most patients have catheters
• Wound: day 3-7
  
  • Diabetes – wound infections can develop very slowly >2-3 weeks
• DVT/PE: day 8 and beyond
  
  • Could be completely asymptomatic, SOB

5 Ws

• Wind: day 1-2 (pulmonary – atelectasis, pneumonia)
• Water: day 3-5 (urine – UTI)
• Wound: day #5-8 (wound infection - if earlier think streptococcal or clostridial infection)
• Walk: day #8+ (thrombosis – DVT/PE)
• Wonder drugs: day #1+ (drug)

Question 2

What is post op respiratory failure?

Answer 2

• Sudden onset SOB, chest pain, tachycardia, fever
• Usually after one week, but can be any time
• DVT prophylaxis with UFH or LMWH and compression stocking is important
• IVC filter when anticoagulation contraindicated
• Treated with IV heparin and warfarin for 3 months if PE?
• Therapeutic range = INR 2-3

Question 3

What investigations should you order for post op delirium?

Answer 3

• FBC, UES, BSL, thyroid function, ABG
• Urine, blood, sputum cultures
• ECG – arrhythmia, heart failure, MI
• CXR, CT/MRI

Question 4

Differentials for post op delirium

Answer 4

• Age
• Alcohol withdrawal
• Drugs: opiates, benzo, steroids
• CVA/oedema/neoplasm
• Metabolic/haemodynamic: electrolytes (esp sodium), hypoxia, hypoglycaemia, hypovolaemia
• Endocrine: hypo/hyperthyroid, adrenal insufficiency
• Sepsis – septic screen as part of workup
• Resp dysfunction: atelectasis, PE
• Liver, renal, cardiac failure
• Critical illness or ICU stay

Question 5

Treatment for post op delirium?

Answer 5

• Haloperidol IV or IM
• Benzos for alcohol withdrawal