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Year 3 - Met3a > Post operative complications > Flashcards

Post operative complications Flashcards

1
Q

What are the risk factors for post-operative complciations

A 
• Poor nutritional state
• Inflammatory state
• Organ failure
• Compromised immunity
• Vascular disease
• Elderly, smoking, DM, obesity 
• Dementia
- patients who are not fully optimised pre-operatively
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2
Q

How do you manage the risk in post operative care

A

Monitoring

  • vital signs
  • fluid balance
  • wounds, stomas, drains
  • monitoring blood results

Medication

  • VTE prophylaxis
  • Antibiotics
  • analgesia
  • Nutrition
  • Enhanced recovery
  • Physiotherapy
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3
Q

What are the three classification for post operative complications

A
  • General complications of surgery
  • complications to specific surgery
  • complications related to pre-exisiting comordbities
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4
Q

Name the general complications of surgery

A
  • Haemorrhage
  • SIRS
  • VTE
  • Wound complications and surgical site infections
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5
Q

Name complications that are specific to surgery

A
  • Anastomotic leak, visceral injury
  • Infected prosthetic materials
  • Dysfunction of operated organ e.g transplanted organs
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6
Q

Name complications that are related to pre-existing comordbities

A

• Cardiovascular/ Respiratory pathologies

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7
Q

name another way of categoriesing post operative complications

A

By time

  • immediate - first 24 hours
  • early - first 4 days
  • late - 5 days onwards
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8
Q

Name examples of immediate post-operative complications

A
  • airway obstruction
  • reactive haemorrhage
  • acute pneumothorax
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9
Q

Name examples of early post operative complications

A
  • acute cerebrovascular event
  • acute myocardial infarction
  • pyrexia
  • post operative urinary retention
  • renal impairment and failure
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10
Q

Name some examples of late post operative complications

A
  • chest/wound/urinary infection
  • secondary haemorrhage
  • DVT/pulmonary embolism
  • wound dehiscence
  • delirium tremens
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11
Q

What is the systematic approach to assesing every patient

A
  • ABCDE
  • Stop if you find a problem; do something, reassess and start from the top again
  • Correct abnormal physiology
  • Re-assess
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12
Q

What is the score to check post operative complications

A

NEWS2

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13
Q

What is NEWS2 based of of

A
  • respiration rate
  • oxygen saturation
  • systolic blood pressure
  • pulse rate
  • level of consciousness or new confusion
  • temperature
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14
Q

What are the actions of NEWS2 based on the scores

A

less than 2
- qualified nurse to review patient at next hand over

score 2-3

  • qualified nurse to review immediatley
  • repeat observations and instigate therapy as prescribed

score 4-5

  • qualified nurse to review immediately
  • repeat observations and instigate therapy as prescribed
  • junior doctor to review within 30 minutes

score 6-7

  • qualified nurse to review immediately
  • repeat observations and instigate therapy as prescribed
  • urgent review by SHO or StR immediately plus inform critical care outreach team of patient

score 8

  • qualified nurse to review immediately
  • repeat observations and instigate therapy as prescribed
  • urgent review by SHO or StR immediately plus
  • urgent review by medical emergency team (MET immediately
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15
Q

What is the point of early warning

A
  • Quantifies the change in observations
  • Allows for early recognition of deteriorating patient which reduces mortality
  • Empowers ward staff to call for help
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16
Q

What is shock

A

Shock is hypoperfusion leading to end organ damage

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17
Q

What are the types of shock

A
  • Hypovolaemic
  • cardiogenic
  • obstructive
  • distributive
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18
Q

What can cause hypovolaemic shock

A
  • Bleeding

- burns

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19
Q

What can cause cardiogenic shock

A
  • MI
  • CCF
  • arrhythmia - metabolic disturbances
  • infection - infective endocarditis
  • cardiac depression in sepsis
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20
Q

What can cause obstructive shock

A
  • tamponade
  • PE
  • tension pneumothorax
21
Q

What can caue distributive shock

A
  • Sepsis

- anaphylaxis

22
Q

What are the classes of hypovalemic shock

A
  • Class I
  • Class II
  • Class III
  • Class IV
23
Q

What is sepsis

A
  • charactersied by a life-threatening organ dysfunction due to a dysregulated host response to an infection
24
Q

What is septic shock

A
  • a subset of sepsis where particulary profound circualtory cellular and metabolic abnormaliteis substantially increase mortality
25
Q

What is the new definition for sepsis

A
  • Change in two point on the sequential organ failure assessment (SOFA) score
26
Q

What is the new tool used for defining sepsis

A

qSOFA score (quick SOFA score)

27
Q

describe how the qSOFA score works

A
  • Respiratory rate of 22/min or greater
  • altered mentation (glasgow coma score of less than 15)
  • systolic blood pressure of 100mmhg or less
  • two of the above is recommended as a screening tool but triggering on an early warning score may be superior
28
Q

what is red flag sepsis

A
  • Red Flag sepsis is not a definitive diagnosis but a tool to empower you to treat the patient
  • It is based on early warning scores
29
Q

describe what makes up red flag sepsis

A

Any one of the following

  • AVPU= V, P or U (if changed from normal)
  • Acute confusion
  • Respiratory rate ≥25 per minute
  • Needs oxygen to keep SpO2 ≥92% (88% in COPD)
  • Heart rate >130 per minute
  • Systolic B.P ≤90 mmHg (or drop >40 from normal)
  • Not passed urine in last 18h/UO <0.5 ml/kg/hr
  • Non-blanching rash, mottled/ashen/cyanotic
  • Recent chemotherapy (last 6 weeks)
30
Q

How do you manage sepsis

A
  1. give high flow oxygen
  2. take blood culutres
  3. give IV antibitoics
  4. give a fluid challenge
  5. measure lactate
  6. measure urine output
  • give 3 and take 3
31
Q

what does MOVE stand for (useful for emergency)

A
  • monritoring
  • oxygen
  • venous access and bloods
  • ECG adn escalate
32
Q

What is a common finding in an ECG of a patient with an PE

A
  • sinus tachycardia - most common sign

- S1, Q waves in lead 3, interveted T waves in lead 3 pattern (only 20% will actually have this)

33
Q

what is mild pyrexia in the first 48 hours following an operation often from:

A
  • atelectasis (need prompt physio, not antibiotics)
  • tissue damage/necrosis
  • blood transfusions
  • infection (although less likely)
34
Q

What investigations do you do for a mild pyrexia after surgery

A
  • Blood - FBC, U&ES, CRP, Cultures +/- LFT
  • urine dipstick
  • consider MSU, CXR, and abode US/CT
35
Q

What are the common causes of confusion after an operation

A
  • hypoxia
  • drugs (opiates, sedatives)
  • urinary retention
  • MI
  • stroke
  • infection
  • alcohol withdrawal
  • liver/renal failure
36
Q

what are the causes of dyspnoea or hypoxia after an operation

A
  • pneumonia
  • pulmonary collapse
  • aspiration
  • LVF
  • PE
  • pnuemothroax
37
Q

How do you investigate dyspnoea or hypoxia after an operation

A
  • FBC
  • ABG
  • CXR
  • ECG
38
Q

What is a drop in blood pressure usually due to in post operative care

A
  • often due to hypovoalemia - check fluid chart and replace losses
  • monitor urine output
  • hypovolaemia may also be caused by haemorrhage so check
39
Q

What can cause an increase in blood pressure in post operative care

A
  • pain
  • urinary retention
  • idiopathic
  • inotropic drugs
40
Q

What is anuria a sign of in post operative care

A
  • may reflect blocked or mispositioned catheter

- AKI

41
Q

What should the aim for urine output be in post operative care

A
  • aim for urine output >30 ml/h in adults
42
Q

How do you manage AKI in post operative care

A
  • Review fluid chart and examine for signs of fluid depletion
  • Examine for urinary retention (palpable bladder)
  • Establish normovolaemia (CVP line may help) IVI or fluid challenge
  • Catheterise bladder for accurate monitoring
  • If intrinsic renal failure is suspected – stop nephrotoxic drugs and refer to nephrologist
43
Q

what should you suspect if you have nausea and vomiting in post operative care

A
  • Any mechanical obstruction, ileus or emetic drugs
44
Q

What is a primary haemorrhage

A
  • continuous bleeding

- starting during surgery

45
Q

How do you treat a primary haemorrhage

A
  • replace blood loss
  • if severe return to theatre for Haemostasis
  • treat shock vigorously
46
Q

What is a reactive haemorrhage and how do you treat it

A
  • Haemostasis appears secure until BP rises and bleeding starts
  • replace blood
  • re-explore wound
47
Q

What is a secondary haemorrhage

A
  • caused by infection

- occurs 1-2 weeks post op

48
Q

what is the stress response to surgery

A
  • This is the name given to the hormonal and metabolic changes which follow injury or trauma
49
Q

Name the components of the stress response to surgery

A
  • Sympathetic autonomic nervous system which results in an increased secretion of adrenaline
  • Anterior pituitary - increased risk of ACTH - leading to increased cortisol risk
  • increased ADH
  • growth hormone is increase
  • increased breakdown of carbohydrates
  • protein metabolism is increased
  • fat metabolism is increased

Year 3 - Met3a (43 decks)

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