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Clinical Specialties - Surgery > Post-Op Complications > Flashcards

Post-Op Complications Flashcards

1
Q

what is the most common pulmonary post-op complication?

A

atelectasis

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2
Q

what is postoperative fever?

A

temp > 100.4 degrees

common within first few post op days

not always infection

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3
Q

what are the possible infectious post op fever causes that should be on your differential?

A

UTI

pneumonia

bacteremia

T/L/D causes

SSI

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4
Q

what are the non-infectious causes of post op fever you should consider in your differential

A

atelectasis (90%)

pain

clots

medications

ETOH withdrawal

transfusion reaction

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5
Q

causes of post op fever - timing

A

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)

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6
Q

what are the zebras of post op fever on the differential?

A

decubitius ulcer

tooth abcess/sinusitis

heart vegetations

GI: acalculous cholecystitis/c diff/ileus/obstruction/rectal abscess

GU: TSS

Neuro: delerium

meds

retained FB

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7
Q

what are the possible sources of CVC infections?

A

colonizing of skin

predisposing to infection

hub contamination

secondary seeding from a bacteremia

contamination of infusate

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8
Q

what are the rare syndromes that can cause a post-op fever

A
  1. malignant hyperthermia
  2. neuroleptic malignant syndrome
  3. serotonin syndrome (serotonin storm)
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9
Q

what is malignant hyperthermia?

A

inherited - autosomal dominant trait

sudden fever > 40C, muscle rigidity metabolic acidosis, intraoperative hemodynamic instability

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10
Q

what is neuroleptic malignant syndrome?

A

high fever

muscle rigidity

altered MS

dysautonomias

(Haldol/anti-eptileptic can cause it)

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11
Q

what is serotonin syndrome?

A

fever, agitation, confusion, tachycardia, rigidity, clonus, tremors

SSRIs and linezolid, lithium, tramadol, meperidine and MOIs

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12
Q

What is the treatment for malignant hyperthermia and neuroleptic malignant syndrome?

A

Dantrolene

(NMS also bromocriptine)

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13
Q

when does it make sense in a post op patient with a fever of unknown origin to give prophylactic antibiotics?

A

hemodynamic instability and signs and symptoms consistent with infection

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14
Q

what are the leading causes of hypotension in post op patients?

A

hypovolemia

systemic infection

iatrogenic

cardiac origin

addisonian crisis (adrenal crisis)

poor ventilation

anaphylaxis

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15
Q

what are three different strategies to combat DVT formation in the post op patient

A

ambulation

compression devices (SCDs)

medication

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16
Q

what are the surgeries where extended (10-35 days) DVT prophylaxis is indicated?

A

major orthopedic surgery

cancer surgery

major abdominal surgery

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17
Q

what are the preferred agents for DVT prophylaxis?

A

lovenox (LMWH)

rivaroxaban (Xarelto)

dabigatran (Pradaxa)

apixaban (Eliquis)

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18
Q

when might you not want to use SCDs for DVT prophylaxis?

A

PAD

open wounds

CHF

superficial venous thrombosis

19
Q

One more time, what is Virchow’s triad?

A

venous stasis

hypercoaguability

vascular injury

20
Q

what are the signs/sx of DVT and the test of choice to diagnose?

A

pain, swelling, warmth and erythema +/- fever

Dx: DUPLEX U/S

21
Q

when is it legitimate to forgo an ultrasound of legs in a postop patient?

A

Wells score <2 and negative D-dimer

22
Q

what are the treatment options for DVT?

A

anticoagulation

Pradaxa and coumadin require LMWH bridge

apixaban and rivaroxaban do not

consider IVC filter

thrombectomy

23
Q

What is the typical presentation for a PE?

A

rapid onset of dyspnea

tachycardia

pleurtic chest pain/cough

hyptension

low sats

calf/thigh pain/swelling (roughly 1/2)

24
Q

What is the standard workup for PE?

A

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)

25
Q

PE treatment

A

supportive therapy

anticoagulation

thrombolysis

(consider IVC filter)

26
Q

What is the first sign of possible renal dysfunction?

A

urine output < 0.55 cc/kg/hr

27
Q

what is movantik?

A

a drug to alleviate opiate-induced constipation

28
Q

what are the common causes of pre-renal dysfunction in the post op patient?

A

hypvolemia during sugery

decreased intravascular fluid

medications

29
Q

what are the most common causes of renal dysfunction in the post op patient?

A

prolonged or uncorrected pre-renal failure

aminoglycosides

amphotericin B

NSAIDS

IV contrast Blood transfusions

30
Q

what are the common causes of post-renal issues in a post op patient?

A

BPH

Foley Catheter clot

31
Q

what is the normal post-op ileus time?

A

0-24 hours in the small intestine

48-72 in the colon

32
Q

how is ileus diagnosed?

A

plain films

CT with IV contrast if needed to ddx from SBO

33
Q

what are the signs and symptoms of ileus?

A

abdominal distension

persistent, diffuse abdominal pain

N/V

inability to pass gas

inability to tolerate a PO diet

34
Q

what are some treatments for ileus?

A

minimize opiods

IV fluids and electrolytes

dietary restriction

GI decompression w/NG tube

35
Q

What are some common causes of small bowel obstruction?

A

post operative adhesions

malignancy

hernia

36
Q

what are the signs and symptoms of C. diff.

A

nausea/vomiting

diarrhea

fever

37
Q

what’s the treatment(s) for C. Diff?

A

IV metronidazole

oral vancomycin 10-14 days

fiduxomicin (Difcid)

38
Q

the presence of what increases the risk of post-op stroke after coronay bypass by 4X?

A

pre-op carotid bruit

39
Q

Patients with what two diseases have a higher risk of post-op seizures?

A

Chron’s and ulcerative colitis

(no one knows why)

40
Q

what’s the best treatment for post-op insomnia in elderly patients?

A

sedating anti-depressants (amytriptyline)

ambien causes delerium

41
Q

what medications are predisposing to post-op delerium?

A

meperidine

benzodiazepines

anticholinergics

antihistamines

anesthetics

opiods

42
Q

what is the treatment for post-operative ETOH withdrawal?

A

benzodiazepenes

pheobarbitol, propofol, tegretol, Keppra

43
Q
A

Clinical Specialties - Surgery (15 decks)

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