POSTOP COMPLICATIONS Flashcards
Shortly after the onset of a general anesthetic with inhaled halothane and succinylcholine, pt experiences rapid rise in temperature to 104. Metabolic acidosis and hypercalcemia is noted. Family member died under general anesthesia before, no details were given.
MALIGNANT HYPETHERMIA: High fevers during operation due to inhaled halothane, resulting in rapid rise in temperature above 104. Patient lacks enzymes to metabolize halothane and succinylcholine- massive muscle twitting = increase in temperature. Treatment: cooling blankets, stop anesthetic, DANTROLENE, correct acisosis, 100% O2. Watch out for myoglobinemia/myoglobinuria.
45 minutes after completion of a urological procedure, patient has chills and fever spike to 104.
BACTEREMIA/SEPTICEMIA is common with urological procedures. Take blood cultures 3x, start emperic abc, with results give specific antibiotic
What are the 5 W’s of postop fevers?
- WIND: day 1 (atelectasis)
- WATER: day 3 (UTI)
- WALKING: day 5 (DVT)
- WOUND: day 7 (wound infection)
- WONDER WHERE: Day 10 (deep access)
Patient complains of shortness of breath and severe retrosternal pain radiating to the left arm POD 2 of abdominal resection.
Patient experienced protracted hypotension and severe bleeding during the surgery.
Consider MYOCARDIO INFARCTION: order EKG and troponins and provide supportive care. do NOT give clot blusters, but rather give heparin or coumadin. Protracted hypotension and severe bleeding during surgery can cause MI during surgery.
POD 5 of a patient with a broken hip who is non ambulatory has prominent distended vies in neck and forehead. Blood gases reveal hypoxemia with hypokapnia (low PO2 and low PCO2)
Pulmonary Embolism: dx with spiral CT scan of the chest or CT angiography. Gold standard to diagnose is PULMONARY ANGIOGRAM.
Tx: heparin to prevent new clots, filter in inferior vena cava.
During an emergency surgery, patient vomits and aspirates while on the OR table.
Tx: wash out tracheal bronchial tree with BRONCOSCOPY.
Steroids could have helped, but only if it is give before the vomiting insult.
A patient with advanced TB, it becomes more and more difficult to bag while on the OR, and blood pressure is starting to decline while CVP increases. There is no evidence of intradominal bleeding.
Consider Tension pneumothorax. Bleb from TB has ruptured. Put in needle through the diaphragm, then place a chest tube.
Two weeks after a stormy postop period in a young patient for multiple gunshot wounds to the abdomen, he becomes progressively disoriented. Bilateral pulmonary infiltrates PO2 is 65 while on 40% O2. He has no evidence of congestive heart failure. What does he have and how do you treat?
Adult Acquired Respiratory Distress Syndrome. Typically occurs in a patient that has been sick for a while. Has patchy lung infiltrates. Tx with PEEP (positive end expiratory pressure). Do not use high volume because it will damage the lungs.
ddx: does he also have a septic process? ARDS can occur after a septic process.
An alcoholic that claims he has not been drinking is in the hospital for an operation becomes disoriented and combative, claims to see elephants crawling up the walls. What does this patient have? How do you treat?
Delirium Tremins. Treatment: benzodiazopenes, 5% alcohol in 5% dextrose (this can be used to treat and to prevent DT).
post op patient with no obvious problems is disoriented and slips into a coma. What do you need?
Blood gasses. disorientation and coma is due to oxygen not getting into the brain.
12 hours after hysterectomy, 42 year old female becomes confused and lethargic, has a grand mal seizure, and goes into a coma. The order for D5W to run at 125 mL/hr was mistakenly implemented as 525 mL/hr.
This patient got a lot of water into her veins. If the patient simply got a lot of water, the kidneys should take care of it. however if this occurs after post operative period, and there has been an outpour of ADH (due to the surgery), the water is retained resulting in WATER INTOXICATION.
To confirm: look at serum sodium concentration.
8 hours after completion of transphenoidal operation, female becomes comatose. Output was at 600 mL/hr when her IV was set at 100 mL/hr.
patient can not retain fluids: AN operation was done in the pituitary gland to remove prolactinoma, however the posterior pituitary or stalk has been damaged = has created DIABETUS INSIPITUS patient can not make ADH.
To confirm: ask for serum sodium concentration. expect <140 mEq/L
A cirrhotic patient goes into a coma after an esophageal shunt for esophageal varices.
Blood is digested by bacteria, resulting in high levels of ammonia released. Liver is not working well and can not metabolize it…?
What is normal urine output?
~1cc/kg/hr.
An average size patient has been urinating for the past three hours the following: 17cc, 10cc, and 12 cc. His systolic blood pressure is normal (he is not in shock). What are the differential dx and how do you figure out what is what?
Is he dehydrated? or acute renal failure.
To dx, give a bolus of fluid. Or look at sodium concentration in the urine. If dehydrated, should be less than 20 mEq/L. If acute renal failure, then kidney will produce sodium concentration above 40. ALso look at FeNa: in renal failure, it exceeds 1.
