Post-Op Complications Flashcards
what is the most common pulmonary post-op complication?
atelectasis
what is postoperative fever?
temp > 100.4 degrees
common within first few post op days
not always infection
what are the possible infectious post op fever causes that should be on your differential?
UTI
pneumonia
bacteremia
T/L/D causes
SSI
what are the non-infectious causes of post op fever you should consider in your differential
atelectasis (90%)
pain
clots
medications
ETOH withdrawal
transfusion reaction
causes of post op fever - timing
Day 1-2 wind: atelectasis
Day 3 water: UTI
Day 5 wound: infection
Day 7-10 walking: PE/DVT/thromboplebitis
wonder drugs: anytime (beta lactams, sulfonamides, nitrofurantonin, heparin, anti-epileptics)
what are the zebras of post op fever on the differential?
decubitius ulcer
tooth abcess/sinusitis
heart vegetations
GI: acalculous cholecystitis/c diff/ileus/obstruction/rectal abscess
GU: TSS
Neuro: delerium
meds
retained FB
what are the possible sources of CVC infections?
colonizing of skin
predisposing to infection
hub contamination
secondary seeding from a bacteremia
contamination of infusate
what are the rare syndromes that can cause a post-op fever
- malignant hyperthermia
- neuroleptic malignant syndrome
- serotonin syndrome (serotonin storm)
what is malignant hyperthermia?
inherited - autosomal dominant trait
sudden fever > 40C, muscle rigidity metabolic acidosis, intraoperative hemodynamic instability
what is neuroleptic malignant syndrome?
high fever
muscle rigidity
altered MS
dysautonomias
(Haldol/anti-eptileptic can cause it)
what is serotonin syndrome?
fever, agitation, confusion, tachycardia, rigidity, clonus, tremors
SSRIs and linezolid, lithium, tramadol, meperidine and MOIs
What is the treatment for malignant hyperthermia and neuroleptic malignant syndrome?
Dantrolene
(NMS also bromocriptine)
when does it make sense in a post op patient with a fever of unknown origin to give prophylactic antibiotics?
hemodynamic instability and signs and symptoms consistent with infection
what are the leading causes of hypotension in post op patients?
hypovolemia
systemic infection
iatrogenic
cardiac origin
addisonian crisis (adrenal crisis)
poor ventilation
anaphylaxis
what are three different strategies to combat DVT formation in the post op patient
ambulation
compression devices (SCDs)
medication
what are the surgeries where extended (10-35 days) DVT prophylaxis is indicated?
major orthopedic surgery
cancer surgery
major abdominal surgery
what are the preferred agents for DVT prophylaxis?
lovenox (LMWH)
rivaroxaban (Xarelto)
dabigatran (Pradaxa)
apixaban (Eliquis)
when might you not want to use SCDs for DVT prophylaxis?
PAD
open wounds
CHF
superficial venous thrombosis
One more time, what is Virchow’s triad?
venous stasis
hypercoaguability
vascular injury
what are the signs/sx of DVT and the test of choice to diagnose?
pain, swelling, warmth and erythema +/- fever
Dx: DUPLEX U/S
when is it legitimate to forgo an ultrasound of legs in a postop patient?
Wells score <2 and negative D-dimer
what are the treatment options for DVT?
anticoagulation
Pradaxa and coumadin require LMWH bridge
apixaban and rivaroxaban do not
consider IVC filter
thrombectomy
What is the typical presentation for a PE?
rapid onset of dyspnea
tachycardia
pleurtic chest pain/cough
hyptension
low sats
calf/thigh pain/swelling (roughly 1/2)
What is the standard workup for PE?
CBC, ABG, BNP, Troponin, D-dimer, EKG, CXR
Positive D-dimer warrants further investigation
Imaging first choice: CT pulmonary angiography
VQ scan (reserved for those who can’t have CT)
