Post Op Complications Flashcards
What are the complications post op
Bleeding Surgical site infection Urinary retention VTE Pulmonary atelectasis Wound dishiscence Pain Nausea and vomiting
When does bleeding occur post op
During surgery - continuous bleeding due to vessel damage
Reactive - bleeding at the end of surgery or early post op (within 24hrs)
Secondary bleeding - 7-10 days post op
What are the signs of haemorrhagic shock
Drop in BP and tachycardia - late signs dizziness Increased pain New nausea Decreased urine output Increased RR
How is haemorrhagic shock managed
A-e assessment
Read notes and know which surgery was performed, if there are drains and where the wound is
Wide bore cannula
IV fluid resuscitation
Urgent senior review
Urgent blood transfusion
Direct pressure applied to bleeding site if seen
What is wound dehiscence
failure of a wound to close properly
What is simple dehiscence
The skin wound alone fails
What may cause a wound to fail to close
Diabetes
Infection
poor nutrition
What is a burst abdomen
Separation of abdominal wall closure with protrusion of the abdominal contents
What is the most common cause of wound dehiscence
Infection therefore early identification and treatment of SSI are important
What are the risk factors for wound dehiscence
Patient factors - age - male - diabetes - steroids - smoking - obesity/malnutrition Intra-operative factors - emergency surgery - abdo surgery - length of operation (>6hr) - wound infection - poor surgical technique
Post operative factors
- prolonged ventilation
- post op blood transfusion
- poor tissue perfusion
- excessive patient coughing
- radiotherapy
What are the clinical features of wound dehiscence
Visible opening typically happens around day 6 post op bleeding inflammation increasing pain
How is wound dehiscence managed
Swabs taken for infection
Bloods taken to look for infection markers
May require return to theatre
contaminated or dead tissue should be surgically debrided and prophylactic abx administered
Resuture wound using deep retention sutures
if immediate close not possible saline -soaked gauze packing
How is sudden full dehiscence managed
Analgesia IV fluids Broad spectrum IV abx Cover wound in saline soaked gauze Urgent return to theatre
What is an abscess
A mass of necrotic tissue containing dead and viable neutrophils suspended in liquefied tissue necrosis
When do post op wound abscesses present
Within 7 days post op with signs of inflammation, pus or a punctum
What are the cardinal signs of inflammation
Rubor - redness Calor - heat Dolor - Pain Tumor - swelling Loss of function