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Medicine II: Surgery > Post Operative Care and Complications > Flashcards

Post Operative Care and Complications Flashcards

1
Q

What is considered the clinically significant indication of a fever?

A

Temp at or above 38.5 C, 101.3 F

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2
Q

What are the main cytokine releasing cells?

A

monocytes, macrophages, neutrophils

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3
Q

What are the main fever associated cytokines?

A

IL-1, IL-6, TNF-alpha, inteferon gamma

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4
Q

Why is a fever higher in a burn patient?

A

They have a higher basal metabolic rate

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5
Q

Most common DDX: (5 Ws)

A 
wind
water
wound
walking
wonder drug
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6
Q

What are examples of wind?

A

atelectasis, pneumonia

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7
Q

What are examples of water?

A

UTI, anastomotic leak

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8
Q

What are examples of wound?

A

wound infection, abscess

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9
Q

What are examples of walking?

A

DVT/PE

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10
Q

What is the most common source of a fever in the first 24 hours?

A

atelectasis

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11
Q

What is the main cause atelectasis in the OR?

A

collapse part of lungs because of artificial ventilation during anesthesia

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12
Q

The fever is from a cytokine release by alveolar macrophages, what will help resolve some of this?

A

deep breathing

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13
Q

What can severely complicate atelectasis?

A

pneumonia

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14
Q

What is the definition of an immediate fever?

A

onset is in the OR or in the immediate post-op period

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15
Q

What are though to be the causes of an immediate fever?

A

medications

necrotizing infection

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16
Q

When medications cause an immediate fever what does it often present with?

A

Hypotension

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17
Q

What are the causative agents of necrotizing fascitis?

A

c. preferinges, group a strep

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18
Q

What is the tx for necrotizing fascitis?

A

ABC, resuscitate, abx (pip/tazo and clindamycin), surgical debridement

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19
Q

What is the definition of an acute fever?

A

fever 1 week after surgery

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20
Q

What are the possible causes of an acute fever?

A 
necrotizing infection
anastomatic leak
pulmonary embolism
MI
pneumonia
aspiration
UTI
SSI
EtOH withdrawal
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21
Q

What is the definition of a subacute fever?

A

fever that occurs greater than 1 week after surgery

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22
Q

What goes into the ddx for a subacute fever?

A 
SSI
UTI
Line infection
abx-associated edema
febrile drug reactions
thrombophlebitis
sinusitis
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23
Q

What is the most common cause of a subacute fever?

A

IV was left in the arm to long causing thrombophlebitis

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24
Q

What is the main cause of a delayed (late) fever?

A

typically a secondary infectious cause

25
What do we look at during a post op fever evaluation?
abc's resuscitate HPI- anesthesia record, op note, nursing report, flow chart PE: look at wounds, look at back for decubitus ulcers, look at drain output check PIV sites, CVL, foley, tubes
26
What labs should you order if you are concerned about an infection?
``` CBC w/diff, sputum, Cx, UCx, Blood Cx x 2 Lumbar puncture (if ams, neck pain, fever) RUQ US (cholecystitis) ```
27
What is a bronchoscope?
a fiber optic scope that looks into airways to assess issues and suction if needed, can also take samples
28
What is the management of a post op fever patient?
removal of infection (foley cath, central lines, peripheral IVs) open, debride and drain infected wounds
29
What values do we look at for a post-op bleeding patient?
VS, labs, drain output
30
What do we need to find out about the blood?
where is it going?: thorax, pelvis, abdomen, extremities, floor
31
What do we check if they are slowly bleeding?
CBC
32
What is the number one reason the patient is bleeding post op?
inadequate hemostasis could also be caused by coagulopathy drugs (coumadin, heparin, plavix)
33
What do you do if you notice the patient is bleeding post-op?
notify the team immediately, may need trip to OR
34
What do we need to do once the bleeding has been identified in the patient? How?
stop the damn bleeding 1. direct manual pressure!!!!! 2. correct coagulopathy (ff plasma, fibrinogen, platelets, vit k) 3. Get labs (HGB/HCT, PT/INR, PTT, iSTAT, rapid TEG, type and cross) 4. resuscitate 5. OR
35
What is a common post op pulmonary complication?
Excessive sedation caused by decreased respiratory drive; want to reverse opiods
36
What post op pulmonary complication is a big killer? What do you do about it?
PE, give heparin and monitor closely
37
What is the main cause of a pulmonary embolism?
DVT
38
What are the symptoms of a PE?
``` tachypnea tachycardia new onset of atrial fib hypoxia hyperventilation ```
39
How do we diagnose a PE post op?
exam, abg, CT angiogram US to look for DVT NO D-DIMERS, theirs are too high already
40
What are risk factors for DVT?
``` cancer obesity smoking old age pregnancy estrogen heart disease immobilization central line surgery ```
41
What is the work up for a hypercoagulable state?
``` antithrombin III def Protein c or protein s def lupus anticoag homocystinuria occult neoplasm connective tissue disorders ```
42
What is the treatment for a DVT?
heparin
43
What are complications of heparin?
HIT- heparin induced thrombocytopenia | caused by and antibody that causes platelet aggregation
44
How do we diagnose HIT?
Send HIT antibody
45
Tx of HIT
Stop heparin, use atixtra or argatroban for large emboli need emergent surgical embolectomy by thoracic surgery
46
What are common post op cardiac complications?
MI bradycardia arrhythmia
47
What is a main cause or the post op cardiac complications?
stress from surgery, mostly from fluid shift
48
What are common post op GI complications?
Ileus bowel obstruction c. difficule colitis
49
How do we treat ileus?
minimize narcotics correct electrolytes, K is most important early ambulation
50
What is significant about a post op bowel obstruction complication?
due to adhesions from surgery, can occur years after abdominal surgery
51
Who commonly gets c. diff?
patients on abx
52
What do we look at to diagnose c. diff?
WBC, can be as high as 50,000
53
How do we treat c. diff?
IV flagyl PO or PR vancomycin
54
How do you treat each of the 5 W's?
Wind – Incentive Spirometry, Nebulizer Water – UA & Culture – Cipro/Nitrofurantoin Walking – Extremity Duplex US - Anticoagulation Wound – Open wound – Wet to Dry Dressings Weird Drugs – D/C drugs
55
What are the basic pincipals for post-op management?
1. Early mobilization 2. Pulmonary therapy 3. Early nutrition - Enteral > Parenteral 4. Adequate fluid & electrolyte administration 5. Manage cardiac risk factors 6. Control blood sugar
56
How do you control blood sugar post-op?
Use sliding scale insulin to maintain regimen
57
How do you manage cardiac risk in post-op?
Pre-existing CAD requires BBs to keep HR < 70
58
How do you push for pulmonary therapy post-op?
incentive spirometry to prevent/correct atelectasis and prevent pneumonia
59
How do you promote early mobilization post op?
OOB on Day 1 to prevent muscle wasting, risk of DVT and return bowel function

Medicine II: Surgery (14 decks)

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