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Clin Specialties - Surgery > Post Op Complications > Flashcards

Post Op Complications Flashcards

1
Q

What is one of the MC post op complications related to pulmonary?

A

atelectasis

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2
Q

What are the common reasons to get post op fever?

A

PNA
UTI
Bacteremia

keep in mind cholecystitis

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3
Q

What is defined as a postop fever?

A

> 38 C (100.4)

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4
Q

What is the most common noninfectious reason for post op fever?

A

Atelectasis

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5
Q

What are some reasons for a noninfectious post op fever?

A 
DVT 
Atelectasis 
medications (antifungals) 
EtOH withdrawal 
pain
transfusion reaction
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6
Q

5 Ws of Postop fever and timing

A

Wind - atelectasis (1,2 d)
Water - UTI (3d)
Wound - SSI (5d)
Walking - DVT/PE/thrombophlebitis (7-10d)
Wonder - drugs (beta lactam, sulfa, nitrofurantoin, heparin, anti-epileptics)

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7
Q

If you have gone down the list of common post op fevers and nothing fits, what are some other causes of fever?

A 
Decubitus ulcer 
sinusitis 
tooth abscess 
C. diff 
ileus 
obstruction 
rectal abscess 
retained foreign body

if there is a fever of unknown cause –finger in every orifice (rectal abscess, left in tampon, etc)

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8
Q

What is the most common central venous catheter line infection?

A

coag-negative staph

be sure to get two blood cultures from different locations so we can confirm this is not just a contamination of the blood sample

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9
Q

Malignant Hyperthermia

A

sudden fever >40C
muscle rigidity
metabolic acidosis
intra-op hemodynamic instability

HEREDITARY (autosomal dominant)

tx. Dantrolene

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10
Q

What is the treatment for malignant hyperthermia?

A

Dantrolene

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11
Q

Neuroleptic Malignant Syndrome

A

high fever
muscle rigidity
altered MS
dysautonomais

haldol can be causative

tx. dantrolene, bromocriptine

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12
Q

What is the treatment for Neuroleptic Malignant Sydnrome?

A

dantrolene

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13
Q

When do you see serotonin syndrome?

A

when giving linezolid (say for MRSA) with a pt on SSRIs

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14
Q

What are the sxs of serotonin syndrome?

A 
fever 
agitation
confusion
tachycardia
rigidity
clonus
tremors
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15
Q

What are the first things you do for an unconscious pt with fever?

A

Blood cultures X2
CXR
Urine culture from foley

look in their mouth, rectum, etc

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16
Q

When do you give prophylactic ABXs for a fever pt?

A

hemodynamically instability as you are getting cultures —start on broad spectrum ABX until the results are back

vanco + cephapin + metronidazole (covers +, -, anerobes)

if the cultures are negative after 48hr - consider d/c abx

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17
Q

Antibiogram

A

data collected from the blood cultures collected in the hospital to determine local susceptibility and resistance

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18
Q

When do you use carbepenams?

A

legit like last resort since they are the BIG guns
when you say “broad spectrum ABX” you are really saying multiple different drugs to cover different possible drugs so you can tailor it back later

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19
Q

MIC

A

Minimum inhibitory concentration

lowest necessary amount of drug needed to disrupt the growth of the bacteria

helps you determine which ABX to use

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20
Q

What can you do for atelectasis?

A

not much we can do
encourage deep breathing
get up and walk around

21
Q

If a pt is going into surgery by has hypotension, what drug should you use?

A

ketamine would be the optimal choice for a pt going into surgery with hypotension

22
Q

Caprini Risk Assessment Tool

A

can be used to determine VTE risk among surgical pts (venothrombus embolism)

23
Q

> 2 score of Caprini Risk assessment tool

A

start pt on heparin or LMWH - DVT prophylaxis

obviously keep in mind the risk of heparin -HIT
if the pt can get up and walk maybe try that instead

24
Q

When is the DVT prophylaxis d/c?

A

once the pt is up walking

25
Q

Which surgeries need extended DVT prophylaxis?

A

Major orthopedic surgery
Cancer surgery
Major abdominal surgery

duration 10-35 days

ideally use Lovenox (lmwh)

26
Q

What are some contraindications of SCDs?

A

peripheral artery disease
open wound
CHF (precaution)
superficial venous thrombosis (saphenous veins)

27
Q

What is the test of choice for DVT?

A

venous duplex ultrasound

if the vein is not compressible there is probably a clot

28
Q

Virchow’s triad

A

venous stasis
vascular injury
hypercoagulability

29
Q

Well’s Criteria

A

To determine if you need a US to r/o DVT
Risk factors in addition to performing a D-dimer
score <2 with negative D-dimer you dont need to US

30
Q

DVT treatment

A

Warfarin (with LMWH bridge) –get PT/INR every 7 days

Eliquis (apixaban)
Xarelto (rivaroxaban)

3 months on tx

Dapigatran needs heparin bridge too

31
Q

Who gets IVC filter?

A

those at risk of PE w/ DVT who cant be on blood thinners

32
Q

What is your first test of choice for PE?

A

CTPA –CT pulmonary angiography

other work up:
CBC, ABG, BNP, troponin, D-dimer, EKG, CXR
if D-dimer is increased you will be getting this CTPA

33
Q

What is the first sing of renal dysfunction?

A

reduction in urine <0.5cc/kg/hr

34
Q

What is the first test of choice for ileus?

A

Abdominal Xray

tells you the difference between SBO and ileus

35
Q

What is the most common cause of SBO?

A

postop adhesions

abdominal Xray
then moving on to CT with IV contrast (looking for free air, perforation, etc)

36
Q

How do you manage SBO?

A

NG tube
NPO
most likely going to surgery –emergency

37
Q

Common ABX that can cause C. diff

A

Clindamycin
flouroquinolones

any ABX CAN cause this

38
Q

What is the treatment for C. diff colitis?

A

Metronidazole (IV or PO)
Vancomycin (PO)
for 10-14 days

No IV Vancomycin because it doesn’t penetrate your colon

new drug - fiduxomicin (Dificid)

39
Q

Who has the highest risk of post op stroke?

A

elderly pt with atherosclerotic dz who has hypotension —-poor cerebral perfusion

40
Q

Pts with ____ and ____ have higher risk of post-op seizures

A

chrones and ulcerative colitis

unknown cause

41
Q

What drugs can we give pts with are withdrawing from EtOH?

A

Benzos (

42
Q

CIWA scale

A

symptom triggered therapy for EtOH withdrawal

43
Q

How do you treat benzo withdrawal?

A

benzo wean off

44
Q

What is the first choice for post op N/V?

A

Zofran (Odansetron)

45
Q

Why do pts have post op puritis?

A

MC side effect of Morphine is itching

tx. ibuprofen might help

46
Q

What is the first test of choice for ileus?

A

KUB xray

Air in colon and rectum

No transition zone on CT

47
Q

Movantik

A

Treats opioid induced constipation

Only after you have tried stool softener and laxative
Then tried senna/docusate

Then if 24 hours goes by you start this Movantik (naloxegol)

48
Q

Flumazenil

A

Reversal agent for benzos

Clin Specialties - Surgery (11 decks)

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