Post-Op Consideratons

Question 1

Post Op fever

Answer 1

Normal (100.8ish) for first day after surgery
#1 cause: atelectasis
thought to be resetting of central thermostat

Question 2

Malignant Hyperthermia

Answer 2

rare complication of general anesthesia
rapid rise in body temp at time of initiation of general anesthesia …..accompanied by metabolic acidosis and hypercalcemia

Question 3

Treatment for Malignant Hyperthermia

Answer 3

IV DANTROLENE 1mg/kg up to 10 mg/kg

correct acidosis
supplement O2
monitor urine output

Question 4

Five W’s of PostOp Fever

Answer 4

Wind: atelectasis (day 1-2) 
Water: UTI (day 3-5) 
Wound: wound infection (5-7) 
walking: DVT 
Wonder drugs: drug fever (dx of exclusion)

Question 5

If fever if high on first day….

Answer 5

think necrotizing soft tissue infection—> strep or clostridium

Question 6

Increased Risk of Post-Surgical infection

Answer 6

Inc Age 
Obesity 
chronic steroid use 
long procedures 
malnutrition 
cold during surgery

Question 7

Wound Hematoma

Answer 7

result of inadequate hemostasis
caution in the neck
non-enlarging hematoma in benign areas may be treated w/ warm compresses

Question 8

Wound Seroma

Answer 8

collection of lymphatic fluid due to surgery in areas high in lymphatic tissue (groin, axilla)

can be aspirated bc fluid is thin!

Question 9

dehiscence

Answer 9

separation of fascial layer

Question 10

evisceration

Answer 10

protrusion of abdominal contents through fascial defect–> surgical emergency

Question 11

Risk factors for wound dehiscence

Answer 11

malnutrition 
morbid obesity 
diabetes
infection 
coughing 
ascites