Postoperative

Question 1

Causes of postoperative fever

Answer 1

Day 1-2 : Pulmonary Atelactasis
Pneumonia
Blood transfusion reaction

Day 2-3 : UTI
IV canula site infection, thrombophlebitis

Day 3-5 : Wound hematoma
Wound infection
Bile leak

Day 5-7 : Pulmonary Embolism
DVT

Day >7 : Drug fever
Attack of gout

Question 2

Postoperative fever in a 45 years old woman who had undergone laparoscopic cholecystectomy yesterday.
How will you assess this patient

Answer 2

1. Charts - vitals charts
   Input-output chart
   Medication chart
   Blood transfusion record
2. Notes - Preoperative notes
   Operation note
   Anaesthetic notes
3. Take history
4. Do physical examination
5. Consider management procedures

Question 3

50 years old man, who underwent knee replacement surgery two days, back is now confused, disoriented and difficult to restrain.
How will you assess his condition.

Answer 3

1. Ensure that patient is not a danger to himself or others.
2. Put him on high flow oxygen and attach a pulse oximeter
3. Ensure IV access through IV cannula
4. Take blood samples
5. Check all the charts, case notes, nursing records, any previous investigation reports
6. Perform focused physical examination on the patient and take history from the family/relatives and nursing staff

Question 4

50 years old man, who underwent knee replacement surgery two days, back is now confused, disoriented and difficult to restrain.
What focused physical examination will you do?

Answer 4

1. All the vital signs
2. Cardiovascular and Respiratory system
3. Abdominal system
4. Evidence of sepsis
5. Evidence of VTE in the legs and chest
6. Neuological deficits

Question 5

What are the causes of post operative confusion?
And what investigations will you do to determine them?

Answer 5

1. Hypoxia (most common) - ABG
   - CXray
   - ECG
2. Hypotension - meaure vitals
3. Infection/sepsis - FBE, Blood C/S, Urine MCS, Chest xray
4. Electrolyte imbalance - Serum UEC, BSL, arterial pH
5. Cardiac (MI or Arrhythmia) - ECG
6. Neurological - physical examination
7. Inadequate pain management - see medication chart
8. Drug or Alcohol withdrawal (VERY common) - history from friends and family
9. Opiate overdose - see medication chart
10. Pre-existing thyroid conditions - TFT

Question 6

Causes of Post operative SOB

Answer 6

1. Pulmonary atelectasis
2. Pneumonia
3. Blood transfusion reaction
4. Pulmonary edema due to heart failure
5. Pulmonary embolism
6. Exacerbation of asthma or COPD

Question 7

Management of Post Operative SOB due to Pulmonary Atelectasis

Answer 7

1. Reassurance
2. Call my registrar
3. Investigations - FBE with ESR and CRP
   - UEC
   - ABG
   - Blood culture
   - Chest xray
   - ECG
4. Refer to the chest physiotherapist to show some breathing exercise
5. Panadol for the pain and fever
6. Attach a pulse oximeter to monitor your SpO2 and give low flow O2 if required
7. Take deep breaths
   Move around
   No smoking
8. Can go back to work in 1-2 days if you feel well

Question 8

Post operative patient with just SOB, no other findings.

What is the diagnosis?

Answer 8

Condition- Pulmonary atelectasis

Cause - 1. Inadequate pain management
2. Past history of smoking
3. Past history of lung diseases
4. Long duration of surgery

Commonality - Very common complication after surgery