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SD- Surg > Post Op Complications Lecture > Flashcards

Post Op Complications Lecture Flashcards

1
Q

Endogenous pyrogen release:
IL-1
IL-6
TNF alpha
Interferon

A

Fever

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2
Q

At what temp do we start to worry post op?

A

38 C

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3
Q

Inflam stimulus
Atelectasis
Surg site infection
Nosocomial pneumonia
UTI
Drug fever
DVT

A

Causes of post op fever

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4
Q

What are the 5 Ws of fever?

A
  • *W**ind
  • *W**ater
  • *W**alking
  • *W**ound
  • *W**onder drugs
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5
Q

Wind (atelectasis) is usually seen on post op day ____?

A

POD 1-2

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6
Q

True or False…

up to 90% of general anesthesia pts get atelectasis

A

True

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7
Q

Causes:

  • *compressive** (positional)
  • *absorptive** (pain with deep inspiration)
  • *combo of absorptive + surfactant dysfxn** (anesthesia, ventilator associated)
A

Atlectasis (wind)

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8
Q

atelectasis usually resolves within..

A

48 hours

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9
Q

if atelectasis remains unresolved, what can develop after 72 hours?

A

pneumonia

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10
Q

How can you prevent atelectasis/pneumonia?

A

Incentive spirometer
Mobility

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11
Q

What is the “Water” cause of post op fever?

POD 3-5

A

UTI

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12
Q

What is the “Walking” cause of post op fever?

POD 4-6

A

DVT

(MC in pelvic, general, ortho surg)

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13
Q

Walking on post op day 1
Pneumatic compression
Antiembolsim stockings
LMWH or UFH
Warfarin
Aspirin

A

DVT prophylaxis

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14
Q

Wound (infection) cause of fever typically occurs on post op day….

A

5-7

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15
Q

Wonder drugs (drugs can cause fever) typically occurs on post op day..

A

7+

(FYI in OB/GYN, the final W is womb)

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16
Q

Atelectasis
Pulmonary edema
Alveolar hypoventilation
Aspiration
Pneumonia

..all causes of?

A

Respiratory failure

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17
Q

Fever
SOB
Gradual decrease in O2 sat
Cough

A

Pneumonia

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18
Q

Ambulation
Cough
Incentive spirometry

all ways to prevent..?

A

Pneumonia

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19
Q

Auscultation
CXR
WBC

..used to dx what?

A

Pneumonia

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20
Q

Tx of post op pneumonia?

A

Chest PT
Antibiotics

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21
Q

Ventilator tubing
ET tube
Humidification fluid

all can cause?

A

Ventilator associated pneumonia

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22
Q

gm neg pseudomonas serratia
gm pos MRSA

A

common pathogens of ventilator associated pneumonitis

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23
Q

How can you prevent ventilator associated pneumonitis?

A

Aseptic technique
Avoid prolonged intubation

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24
Q

Immobility
Hypercoaguable secondary to surg
Tobacco use
Estrogen
Increase age and comorbities

A

Risk factors for VTE

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25
Q

is a D-Dimer useful in post-op patients?

A

NO

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26
Q

How do you diagnose a VTE?

A

venous doppler

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27
Q

2 kinds of PE?

A

Clinically significant

Non clinically significant

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28
Q

Sudden SOB
Pleuritic CP
Fever
Sudden hypoxemia
Tachycardia
Cough/hemoptysis

A

PE

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29
Q

Dx via:

Chest CT Angiogram
VQ scan

A

PE

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30
Q

Post op arrhythmias:

Atrial tachycardia
Atrial fibrillation
Ventricular arrhythmias

..MC after what type of surgeries?

A

Cardiac
Thoracic

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31
Q

Hypoxia
Hypovolemia
Hyperthermia
Electrolyte imbalance
Hypoglycemia
HTN
Infection
Meds

A

causes of post op arrhythmias

32
Q

MC cause of morbidity and mortality after non cardiac surgeries?

A

MI

33
Q

Typically occurs within 5 days of surgery

Post op ischemia on EKG is ominous sign*

May occur with arrhythmia

A

MI

34
Q

signs:
HF, unexplained SOB, tachycardia, hypotension
may no present with typical CP

Tx: consult with surgeon

A

Post op MI

35
Q

Dyspnea
Hypoxemia w normal CO2 tension
CXR with increased vascular markings

A

Heart failure/pulmonary edema

36
Q

Reduce preload (diuretics)
Possibly digitalis
Inotropic support
Invasive monitoring if in shock
Ventilatory support as needed

A

Post op HF tx

37
Q

Manipulation of heart and aorta
Particulate release from ECMO

..early or late perioperative stroke?

A

Early

38
Q

Emboli from Afib
Supply/demand MI
Coagulopathy

..early or late perioperative stroke?

A

Late

39
Q

Advanced age
Non-elective surgery
Female sex
EF <40%
Vascular disease
DM
Creatinine >2mg/dl or dialysis

A

Pt dependent risk factors

40
Q

Acute mechanical failure of the wound closure

A

Dehiscience

41
Q

Mechanical force
Tissue ischemia due to tight suturing
Poor suturing technique
Local infection

..causes of?

A

wound dehiscience

42
Q

True or False…

14-16% of all infections in hospitalized pts are post op wound infections

A

True

43
Q

Most post op wound infections require…

A

surgical debridement

44
Q

Is induration a normal sign with a wound?

A

YES

45
Q

Redness
Swelling
Localized heat
Increased pain
Dehiscience
Tachycardia
Fever (late)

A

signs of infection

46
Q

Non abdominal surgeries
No gross contamination

..which classification?

A

Clean

47
Q

Elective GI surgeries
Lightly contaminated

..which classification?

A

Clean contaminated

48
Q

“Spill” during elective surgery
Perforated gastric ulcer

..which classification?

A

Contaminated

49
Q

Intestinal infarction
Intra abdominal abscess drainage

..which classification?

A

Contaminated

50
Q

Infected
Intestinal infarction
Intrabdominal abscess drainage

..which classification?

A

Dirty

51
Q

Source:
pt skin
OR environment
surgical team

contaminant: gm +

A

Clean wound infection

52
Q

Limit pre-op hosp
Pre-op shower
Chlorhexadine bath
Hair removal
Avoidance of adhesive drapes
Decrease OP time

A

Ways to prevent infections

53
Q

Decreased suture material
Decreased cautery
Drains

A

Procedural infxn prevention

54
Q

Endogenous colonization

Polymicrobial contaminant

  • frequently gm neg
  • anaerobes
A

Clean contaminated

55
Q

Source: gross contamination

polymicrobial contamination

A

Contaminated wound infection

56
Q

Abx must be present at time of contamination!!

give pre op abx <60 min of incision
re dose 4-6 hours later
< 3 post op doses

A

Contaminated wound infxn

57
Q

Should you give long term abx for contaminated wound infections?

A

NO

58
Q

Source: established post op infection

polymicrobial

A

Dirty wound infection or intra-abdominal abscess

59
Q

Spore forming gm + anaerobic bacillus

carriage by 20-50% of adults in hospitals and LTC

A

C dif

60
Q

Associated with abx, esp clindamycin and fluoroquinolones

A

C dif

61
Q

Fecal/oral transmission

Spores resistant to heat, acid, alcohol, and abx

sporilates in the presence of waterless hand wash (must be washed down the drain)

A

c dif

62
Q

PO metronidazole
PO vanco (NO IV)
PO vanco plus IV metro

A

C dif

63
Q

MC nosocomial infection

A

UTI

64
Q

Preexisting urinary tract contamination
Urine retention
Instrumentation

A

UTI risk factors

65
Q

5% of catheter pts will develop bacteriuria within 48 hours of palcement

but only __% will develop a UTI

A

1%

66
Q

Dysuria and mild fever

A

Cystitis

67
Q

Hydration
Bladder drainage
Specific abx

A

UTI tx

68
Q

Temporary paralysis of a portion of the bowels

typically follows abdominal surgery
may accompany any abdominal infxn or trauma
risk with any surgery

A

post op ileus

69
Q

N/V
Vague abdominal symptoms

dx: abdominal X ray
Clinical impressiong (**quiet bowel sounds**)
A

Paralytic ileus

70
Q

Tx:

NPO
NG tube
IVF/nutrition (D5 IV)
Support

*do no jump right to TPN

A

Paralytic ileus

71
Q

Hypermetabolic condition of muscle

Muscle necrosis and Rhabdomyolysis may occur
Potentially fatal
Associated w autosomal dominant mutations

A

Malignant hyperthermia

72
Q

Malignant hyperthermia triggers?

A

Extreme stress
Anasethetic agents

73
Q

Abrupt increase in ETCO2
Possible massester rigidity
Increased body temp (may be delayed up to 36 hrs)
Tachycardia
Cyanosis
Muscle rigigity

A

Malignant hyperthermi

74
Q

True or False…

With malignant hyperthermia, an increased body temp may be delayed up to 36 hours after trigger

A

True

75
Q

Compartment syndrome
Rhabdo
Acidosis (resp and metabolic)
Arrhythmias/sudden cardiac arrest

A

Malignant hyperthermia late effects

76
Q

Check family hx

Muscle biopsy with stimulated contaction studies

A

Ways to prevent malignant hyperthermia

77
Q

Discontinue triggering agent

Dantroline

Cooling blankets (without shivering)

Renal support

Search for occult compartment syndrome

Respiratory support

A

Malignant hyperthermia tx

SD- Surg (2 decks)

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