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Year 3 Surgery block > Post operative management > Flashcards

Post operative management Flashcards

1
Q

Risk factors for post-op wound infections?

A 
Contaminated operations 
Long procedures - more than 2 hrs
Diabetes 
Obesity 
Smoking 
Immunosuppresion
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2
Q

Management of mild wound infections?

Mild = erythema, no fever.

A

Analgesia
Regular wound dressing
Oral abx

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3
Q

Management of severe wound infections?

Severe = discharge, fever, abscess present

A

Wound swabs
IV abx
Reopen wound if abscess present
Allow wound to heal by secondary intention

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4
Q

What is wound dehiscence?

A

Separation of a surgical wound - especially after abdominal surgery
Life-threatening post-op complication

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5
Q

How to manage wound dehiscence?

A
  1. Cover wound with WET sterile gauze (usually soaked in saline)
  2. Transfer to theatre for re-suturing
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6
Q

Aim of peri-operative abx?

A

Prevent post op wound infections

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7
Q

How to prevent post-op complications/enhance recovery?

A 
Good prep for surgery (diet, exercise)
Minimally invasive choice of surgery 
Adequate analgesia 
Good nutrition 
Early return to oral diet and fluid intake 
Early mobilisation 
Avoid drains, NG, early catheter removal 
Early discharge
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8
Q

Causes of post-op N+V?

A 
Surgical procedure 
Anaesthetic 
Pain 
Opiate use/drugs 
Paralytic ileus 
Infection
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9
Q

RF for post-op N+V?

A 
Female 
Hx of motion sickness or post op N+V
Non-smoker 
Use of opiates post-op 
Younger age 
Use of volatile anaesthetics
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10
Q

Management of post-op N+V?

A

Anti-emetics
Minimise movements
IV fluids if dehydrated
Analgesia

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11
Q

Commonly used anti-emetic options for post-op N+V?

(I.e ones given on post op ward, not ones given as prophylaxis in op).

A

Ondansetron
Prochlorperazine
Cyclizine

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12
Q

Causes of post-op reduced urinary output?

A 
Pre-renal 
- hypovolaemia 
- hypotension 
- dehydration 
Renal 
- acute tubular necrosis 
Post-renal 
- BPH
- anticholinergics or alpha blockers (used as anasthetics)
- pain 
- psychological inhibition 
- opiate analgesia
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13
Q

Causes of post-op pyrexia?

A 
5Ws
Wind - pneumonia, atelectasis 
Water - UTI 
Wound - infection 
Wonder drugs - anaesthesia
Walking - DVT

also can be caused by developing abscess.

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14
Q

What post op complications can occur?

A 
Anaemia
Atelectasis 
Infections 
Wound dehiscence 
Ileus 
Haemorrhage 
DVT and PE 
Shock due to hypovolemia, sepsis, HF,
Arrhythmias  
MI and stroke 
AKI 
Urinary retention 
Delirum
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15
Q

In a wound management how would you perform a systematic assessment of the wound? TIMES mnemonic

A

Tissue involved (viable or non viable)

Infection or inflammation

Moisture levels

Edge of the wound

Surrounding skin

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16
Q

What should you assess in terms of patient factors when thinking of wound management?

A

identify factors that are detrimental to wound healing.

Control or eliminate those factors as dressings do not heal wounds, the patient does

17
Q

what are some different types of wounds?

A

MANY!

Simple uncomplicated wounds

large or complex wounds

infected wounds

necrotic wounds (with or without infection)

sloughy wounds

granulating wounds

epithelializing wounds.

18
Q

General aims for wound management: wounds should be kept in what state to enable healing?

A

Clean
protected
environment to facilitate healing

19
Q

What is negative pressure wound therapy ?

A

VAC - (vacuum assisted dressing) is trade name

Aids the haling of wounds

temporise them before formal reconstruction

20
Q

How does negative pressure wound therapy aid healing ?

A

-ve pressure encourages blood supply, reduces oedema and don’t need lots of dressing changes.

encourages cell activity and perfusion, stimulates granulation tissue formation

sealed dressing covers the wound and set to negative pressure which removes exudate int o collecting canister.

21
Q

What are contraindications for negative pressure wound therapy?

A

exposure of blood vessel or bowel

infection

significant tissue necrosis needing debridement.

22
Q

What wounds is negative pressure wound therapy good for?

A

Larger wounds

23
Q

In surgery how are most wounds managed ?

A

Secondary intention healing

or

primary closure

24
Q

What is primary closure ?

A

Small wound with edges that can be easily opposed e.g. scalpel incision

4 stages: 
Haemostasis 
Inflammation 
proliferation 
remodelling

END RESULT - minimal scaring + complete return to function

25
Q

What is secondary intention healing?

A

Side of wounds not opposed so healing occurs form base of wound upwards

4 stages: 
Haemostasis 
Inflammation 
proliferation 
remodelling

Myofibroblasts VITAL IN SECONDARY
contract wound and bring edges together and deposit collagen for scar healing.

26
Q

Which is faster primary closure of secondary intention healing?

A

primary

27
Q

What complication can you get in people with darker skin from wound healing

A

Keloid scars

28
Q

What cell is only involved in secondary intention wound healing ?

A

Myofibroblasts - actin and myosin contract to pull wound edges together and deposit collage for scar formation

29
Q

What are some wound management options in surgery “The reconstructive ladder” for stepwise wound management?

A 
Secondary intention
Primary closure
Delayed primary closure
Split thickness graft
Full thickness skin graft
Tissue expansion
Random flap
Pedicled flap
Free flap
30
Q

What are the two types of skin grafting available? and how do they differ?

A

Split-skin thickness skin graft (SSG) – does not contain the whole dermis

Full-thickness skin graft (FTSG) – contains the whole dermis (also transplanting hair follicles)

31
Q

What is a skin graft ?

A

a surgical operation in which a piece of skin is transplanted to a new site on a patient’s body.

32
Q

When are skin grafts necessary?

A

Skin grafts are necessary when the wound cannot be closed primarily and delayed healing is not appropriate.

A skin graft has no blood supply, and therefore depends on the vascularised bed where it is placed.

33
Q

When is an example of a situation that might need a slit-skin thickness graft?

A

Split-skin grafting is often used for larger areas that require cover (for example in burns surgery) and they can be meshed to increase their size.

34
Q

An example of a situation that might need a full thickness skin graft?

A

Full thickness grafts are used for smaller areas, e.g. face for a better cosmetic appearance.

Can only use areas with surplus skin e.g. supraclavicular fossa, pre/post auricular regions, groin, medial arm

Year 3 Surgery block (66 decks)

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