Post Op Complications Flashcards
What is one of the MC post op complications related to pulmonary?
atelectasis
What are the common reasons to get post op fever?
PNA
UTI
Bacteremia
keep in mind cholecystitis
What is defined as a postop fever?
> 38 C (100.4)
What is the most common noninfectious reason for post op fever?
Atelectasis
What are some reasons for a noninfectious post op fever?
DVT Atelectasis medications (antifungals) EtOH withdrawal pain transfusion reaction
5 Ws of Postop fever and timing
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)
If you have gone down the list of common post op fevers and nothing fits, what are some other causes of fever?
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)
What is the most common central venous catheter line infection?
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
Malignant Hyperthermia
sudden fever >40C
muscle rigidity
metabolic acidosis
intra-op hemodynamic instability
HEREDITARY (autosomal dominant)
tx. Dantrolene
What is the treatment for malignant hyperthermia?
Dantrolene
Neuroleptic Malignant Syndrome
high fever
muscle rigidity
altered MS
dysautonomais
haldol can be causative
tx. dantrolene, bromocriptine
What is the treatment for Neuroleptic Malignant Sydnrome?
dantrolene
When do you see serotonin syndrome?
when giving linezolid (say for MRSA) with a pt on SSRIs
What are the sxs of serotonin syndrome?
fever agitation confusion tachycardia rigidity clonus tremors
What are the first things you do for an unconscious pt with fever?
Blood cultures X2
CXR
Urine culture from foley
look in their mouth, rectum, etc
When do you give prophylactic ABXs for a fever pt?
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
Antibiogram
data collected from the blood cultures collected in the hospital to determine local susceptibility and resistance
When do you use carbepenams?
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
MIC
Minimum inhibitory concentration
lowest necessary amount of drug needed to disrupt the growth of the bacteria
helps you determine which ABX to use
What can you do for atelectasis?
not much we can do
encourage deep breathing
get up and walk around
If a pt is going into surgery by has hypotension, what drug should you use?
ketamine would be the optimal choice for a pt going into surgery with hypotension
Caprini Risk Assessment Tool
can be used to determine VTE risk among surgical pts (venothrombus embolism)
> 2 score of Caprini Risk assessment tool
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
When is the DVT prophylaxis d/c?
once the pt is up walking
