Post Operative Complications Flashcards
Name and Describe the 2 main of antiemetics including mech of action and dosing and SEs
Cyclizine: anticholinergic, antihistamine 50mg tds
SEs: xerostimia, drowsiness
Ondansetron: 5HT3 antagonist 1-8mg tds
SEs: headache, flushing, constipation
Describe risk factors for post op nausea and vomiting
Patient factors: Motion sickness Anxiety Children Women Hypo or hypertension Pain Dehydration Non smokers Family history
Surgery: Gynae, ENT, GI, long duration, emergency, laparoscopic
Anaesthetics: gases eg n2o, opioids, ketamine, etomidate, spinal, CPAP (gastric dilation), duration,
Define pain
Unpleasant sensory and emotional experience associated with actual or potential tissue damage
Why is pain a problem post op
Delays recovery
Increased risk of chest infection as avoid coughing and deep breaths
Stress-> nausea vomiting, hypertension, tachycardia, increased oxygen demand -> cvs complications
Increased risk of DVT and PE due to immobility
Urinary retention
Psychological recovery delayed
Name some pain scoring systems
- Verbal rating scale: no pain- Extremely intense
- numerical rating scale: 0-10
- Visual analogue scale: 10 cm line
- faces for kids
What is Post Operative Cognitive Disorder?
Confusion and disorientation with signs of anxiety and stress after anaesthesia and surgery. Short term (usually) decline in cognitive function.
What are the risk factors for post operative cognitive disorder?
Drugs: midazolam morphine, codeine, anticonvulsants, barbiturates
Infection: pneumonia, UTI, sepsis, MRSA, C Dif
Hypoxia: pneumonia, PE, atelectasis, LVF, shock
Other factors: elderly, alcohol withdrawal, existing cognitive dysfunction, metabolic syndrome, duration and type of op.
Describe the 'at risk time' after surgery for: 1- DVT/PE 2- Bleeding 3- Anastomotic leak 4- infection 5- MI
DVT usually occurs around day 7 to 12
bleeding is more immediate and over the next few days
Anastomotic leak may be immediate during op if it is a poor anastomosis, or usually 5 days later and throughout the coming month or so
Wound Infection usually takes about 5-7 days to develop, abscesses occur 10-14 days after.
MI usually occurs on day 3
Why is hypothermia an issue post op
Reduces clotting so Increased risk of bleeding
Shivering increases O2 demand so increases MI risk
Increases stay on the ward as can’t be discharged until normal temp
Describe the diagnosis and management of post-op ileus
Predisposed by abdominal surgery, opioid use
Normal recovery time:
Small bowel: 0-24hrs
Stomach: 24-48hrs
Large bowel: 48-72hrs
Ask if the patient has passed flatus as this indicates colon, and thus total GI, recovery.
If prolonged ileus occurs make the patient NBM and drain the stomach via NG only giving fluids while you wait for recovery.
How do we manage c Dif?
Stop antibiotics, PPIs, steroids, laxatives
Give metronidazole or vancomycin
Name the likely bacteria and antibiotic used for a wound infection?
MRSA, strep, coagulate -ve staph, staph aureus, E. coli plus in immune compromise candida and pseudomonas
Give flucloxacillin or vancomycin for MRSA
What bacteria might cause intraabdominal abscess? How is it treated?
E. coli, staph aureus, enteric organisms
Amoxicillin&metronidazole&gentamycin
Name some risk factors for DVT or PE after surgery
Immobility OCP/HRT/pregnancy Obesity Varicose veins Cancer History of VTE Smoking Dehydration Long surgery Leg/ hip surgery
How do we treat a DVT or PE
O2 and Intubation if PE Hydrate and elevate Heparin 4-7 days Streptokinase Thrombectomy
