Post op scenarios management

Question 1

Early complications post hemiarthroplasty

Answer 1

Procedure-related:

• Haematoma / infected haematoma
• Fat embolism syndrome
• Wound infection

Associated morbidity:
Pneumonia
Atelectasis
Pulmonary oedema (over administration of fluids with background of IHD or CCF)
DVT / PE

Question 2

ECG findings of PE

Answer 2

Sinus tachycardia = most common

S1 Q3 T3
= acute cor pulmonale
Large s-wave in lead I
Q wave in lead III
Inverted T-waves in lead III

Question 3

Wells score

Answer 3

Risk stratification tool to provide pre-test probability of PE
-Not for diagnosing PE

Can be three tier or two tier classification

• Three tier: low, moderate, and high
• Two tier: unlikely, likely

Scoring:
Clinical signs and symptoms of DVT (yes = 3)
PE is #1 diagnosis OR equally likely (yes = 3)

Heart rate >100 (yes = 1.5)
Immobilization at least 3 days OR surgery in the previous 4 weeks (yes = 1.5)
Previous, objectively diagnosed PE or DVT (yes = 1.5)

Hemoptysis (yes = 1)
Malignancy w/ treatment within 6 months or palliative (yes = 1)

<4 = unlikely, hence consider d-dimer

> 4 = likely –> do CTPA

Question 4

Presentation of anastomotic leak

Answer 4

Any change in physiology e.g. AF, SVT

Pain

Rigid abdomen

Tachycardia

Fever

Haemodynamic instability

Indolent: failure to thrive, prolonged ileus

Signs: faecal discharge from wound, fever, tachycardia, peritonitis

Question 5

Investigations and management for anastomotic leak

Answer 5

Investigations

• CT abdopelvis = gold standard
• Contrast enema

Management

• Faecal diversion
• Hartman’s procedure
• Re-do

Question 6

Surviving sepsis campaign

Answer 6

Introduced by the European Society of Intensive Care Medicine

Decreased mortality from sepsis

Factors:

• time to recognition of sepsis from admission <2 hours
• having a lactate test
• having antibiotics
• having blood cultures pre-antibiotics

If hypotensive, or lactate >4 –>30ml/kg fluid bolus