Post-Operative Care

Question 1

RFs for post operative complications

Answer 1

Poor nutritional state
Inflammatory state
Organ failure
Compromised immunity
Vascular disease
Elderly, smoking, DM, obesity
Dementia
Patients not fully optimised pre-operatively

Question 2

Post operative care consists of

Answer 2

Monitoring vital signs + fluid balance
Wounds, stomas, drains
Monitoring blood results
Medication- VTE prophylaxis, antibiotics, analgesia
Nutrition
Enhanced recovery 
Physiotherapy

Question 3

General complications of surgery

Answer 3

Haemorrhage
SIRS
VTE
Wound complications and surgical site infections

Question 4

Complications to specific surgery

Answer 4

Anastomotic leak, visceral injury
Infected prosthetic materials
Dysfunctions of operated organ e.g. transplanted organs

Question 5

Complications related to pre-existing co-morbidities

Answer 5

Cardiovascular/respiratory pathogens

Question 6

The 5 Ws of post-operative pyrexia

Answer 6

Infectious sources in the post-operative period predominately originate from the lung (“wind”, days 1-2), urinary tract (“water”, days 3-5) and surgical site infections or abscess formation (“wound”, days 5-7).

Question 7

PARS meaning

Answer 7

Patient at risk score

Question 8

MEWS meaning

Answer 8

Modified early warning score

Question 9

NEWS meaning

Answer 9

National early warning score

Question 10

NEWS2 based on

Answer 10

Resp rate
Oxygen sat
Systolic BP
Pulse rate
Temp
Level of consciousness or new confusion

Question 11

Class I shock

Answer 11

Blood loss <750 ml (<15%)
HR normal or minimally increased
Normal ventilatory rate
Normal systolic BP
Normal urine output

Question 12

Class II shock

Answer 12

Blood loss 750-1500ml (15-30%)
>100 HR
20-30 ventilatory rate
Normal systolic BP
20-30ml/hr urine output

Question 13

Class III shock

Answer 13

Blood loss 1500-2000ml (30-40%)
>120 HR
30-40 ventilatory rate
Decreased systolic BP
5-15ml/hr urine output

Question 14

Class IV shock

Answer 14

>2,000ml blood loss (>40%)
>140 HR
>35 ventilatory rate
Greatly decreased systolic BP
Minimal urine output

Question 15

Hypovolaemic shock

Answer 15

Bleeding

Question 16

Cardiogenic shock

Answer 16

MI

CCF

Question 17

Obstructive shock

Answer 17

Tamponade
PE
Tension pneumothorax

Question 18

Distributive shock

Answer 18

Sepsis

Anaphylaxis

Question 19

Sepsis definition

Answer 19

Characterised by a life threatening organ dysfunction due to a dysregulated host response to infection

Question 20

Septic shock

Answer 20

Subset of sepsis where particularly profound circulatory, cellular and metabolic abnormalities substantially increase mortality

Question 21

qSOFA screening tool

Answer 21

Two of below recommended as screening tool for sepsis
Resp rate of 22/min or greater
Altered mentation (glasgow coma scale of less than 15)
Systolic BP of 100mmHg or less

Question 22

Sepsis Six

Answer 22

Give high flow oxygen
Take blood cultures
Give IV antibiotics
Give a fluid challenge
Measure lactate
Measure urine output

Question 23

Sepsis Six- Give (3)

Answer 23

high flow O2
antibiotics
fluids

Question 24

Sepsis Six- Take (3)

Answer 24

bloods for lactate
cultures
urine output measurements/MC+S

Question 25

Cardiogenic shock post op

Answer 25

Acute MI
CCF
Arrhythmia- metabolic disturbances
Cardiac depression in sepsis 
Other- acute mitral regurg (papillary rupture), ventricular septal rupture, ischaemia, valvular disease (regurgitation, stenosis), cardiomyopathy