Post-operative Complications

Question 1

What are the causes of post-operative pyrexia?

Answer 1

1. Waves - ECG changes, MI
2. Wind - atelectasis, pneumonia
3. Water - UTI
4. Wound - surgical incision site
5. Walking - VTE
6. Wonder drugs - drug related fever

Question 2

How is a post-operative pyrexia investigated?

Answer 2

FBC, U&Es, CRP, cultures, dip the urine, CXR, CTPA if PE suspected.

Question 3

What are the causes of confusion post-operatively?

Answer 3

1. Hypoxia - pneumonia, atelectasis, LVF, PE
2. Drugs - opiates, sedatives
3. Urinary retention
4. MI/stroke
5. Infection
6. Alcohol withdrawal
7. Liver/renal failure

Question 4

What are the causes of dyspnoea/hypoxia post-operatively?

Answer 4

1. Pneumonia, pulmonary collapse, aspiration
2. LVF (MI, fluid overload)
3. PE
4. Pneumothorax

Question 5

How is post-op dyspnoea/hypoxia investigated?

Answer 5

FBC, ABG, CXR, ECG

Question 6

What are the causes and management of hypotension post-operatively?

Answer 6

1. Inadequate fluid input - monitor urine output
2. Haemorrhage - review wounds, drains, abdomen; return to theatre if unstable.
3. Sepsis and anaphylaxis
4. Look for evidence of MI, PE

Question 7

What could be causing post-op hypertension?

Answer 7

Pain, urinary retention, idiopathic (missed drug), or inotropic drugs.

Question 8

How should you manage post-op oliguria?

Answer 8

1. Aim >0.5ml/kg/hr
2. Examine for palpable bladder (retention), catheterise to treat.
3. Anuria may reflect blocked catheter (flush)
4. Review fluid chart - fluid challenge may be needed

Question 9

What are the typical causes of post-op nausea and vomiting and how is it managed?

Answer 9

1. Mechanical obstruction, ileus or emetic drugs.

2. Consider AXR (obstruction) and anti-emetic (not metoclopramide as it is pro-kinetic)