Post-op complications Flashcards
Early rest complications
Commonly
- Underlying lung disease
Pneumothorax
- Positive pressure ventilation
ARDS
- Usually sick previously
Opiate overdose- respiratory depression
- Resp depression, pin point pupils, coma.
Atelectasis
- Alveolar collapse due to secretions sit
- Poor ventilation
Infection
Embolism
Early complications
- Bleeding
Primary
- At surgery
Reactionary
- Few hours after surgery
Secondary
- 5-10 days post surgery
Grades of hypovolaemic shock
1- <15% blood loss
- Resp rate is the most sensitive (14-20)
2- 15-30%
- RR= 20-30
- Increased DBP
- Urine output= 20-30mL
3- 30-40%
- Urine output 5-15
- BP drops
- RR= 30-40
- Tachycardia
4- >40%
- Anuria
SIRS
- 4 features
Tachycardia
- >90
Tachypnoea
- >20
Temperature
- >38, <36
WCC
- >12, <4
Sites of sepsis
Lines
- Cannulae, change every 72 hrs
- Central lines, change every 7 days
Urinary
Wound
Chest
Abdomen/pelvis
C. difficile
- Antibiotics.
Risk factors for wound infection
Cardio/ resp
- Age
- Resp disease
- Smoking
- DM
- Obesity
Organ failure
Steroids
Local factors
- Faecal peritonitis
- Emergency
- Irradiation
- Lower midline incision= more stretch
Malignancy
Wound infection management
Swab- culture
Mark extent of cellulitis
Blood tests
- Inflammatory markers
- Culture
Appropriate antibiotics
Drain abscess/ stoma bag
Risk factors for DVT
- Stasis
- Endothelial trauma
- Hypercoaguability
Stasis
- Long operation
- Ortho surgery
- Pregnancy
DVT prophylaxis
Thromboembolic stockings
Intraoperative compression
- compresses veins by inflating and deflating
LMW hep/ Unfractionated hep (kidney failure)
Early mobilisation
Late complications
Incisional hernia
Operation specific
- I.e stoma retraction
Recurrence of cancer
Adhesions
Keloid scarring/ hypertrophic scars
UTI post op management
ABCDE
Sepsis 6
Local antibiotic guideline
Transfusion reaction
- Signs and symptoms
- Management
Mild
- Hives and itching
Fevers/chills
Hypotension
Dyspnea
- Volume overload
Management
- Stop transfusion
- ABCDE
- IV steriods/ adrenaline
Post-op tachycardia causes
Pain
Infection
Bleeding
Reaction: drug, transfusion
Compartment syndrome
Reduced urine output post-op causes
Dehydration/ inadequate fluid input/ fluid loss
Catheter blocked
Urinary retention
SIADH
Contrast reaction
Ureter damage
Late-complications (Day 4-30)
Infection
- Wound/ skin
- Chest
- Urinary
- Abdomen
- Head
Anastomosis leak (especially day 3/4)
DVT/ PE
DVT risk factors
Previous DVT
Post-op ileus
- description
- symptoms
- Treatment
Physiological response to abdominal surgery
- Lack of peristalsis, normal a few days after surgery.
- > 4 days= prolonged ileus
Symptoms
- Nausea, vomiting
- Bowel distention
- Abdo pain
Treatment
- IV fluid
- good fluid balance
- Consider NG tube if they are vomiting
- Nutritional support may occur
Anastomotic leak
- Description
- Signs and symptoms
- Management
Usually occurs 3-4 days post-op
Lack of perfusion to anastomosis can cause it to breakdown and leak bowel contents into the abdomen.
Signs and symptoms
- Worsening abdominal pain
- Vomiting
- Failure to progress
- Tachycardic, temperature, febrile, tachypnoea.
Management
- Warm saline to wash out the abdominal and pelvic cavity.
- Complication: collection can form after washing out
Bile leak
- Description
- Presentation
- Management
Cholecystectomy complication
- Usually when common bile duct is being mobilised to reach the gallbladder and causes damage to biliary tree
- 2-10 days post-op
Presentation
- Abdominal pain
- Fever
- CRP may be raise
Management
- ABCDE
- antibiotics
- Drainage and specialist repair (stent or surgical repair)
Wound complications
Dihescence
- Tension/ pressure in wound
Haematoma
Skin infection
Stitch abscess
- Occurs when suture is too close to the skin so infection pockets into skin
Seroma
- Post-op collection of interstitial fluid due to soft reaction
Delayed complications (30 days+)
- Hernia
- Bowel resection
- Splenectomy
- Scar
- Transplant
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