Postoperative Care 2

Question 0

Postoperative patient with 105 fever – wound appears erythematous with advancing edge of brown skin discoloration and bleb formation. Suspected diagnosis? Later finding? Treatment?

Answer 0

Serious wound infection such as clostridium.

Crepitus – absence or not delayed diagnosis

1. Open wound and culture immediately
2. If Clostridium, high-dose penicillin and debridement
3. Hyperbaric oxygen to inhibit germination of heat activated two boys
4. Tetanus immunization

Question 1

Postoperative patient 12 hours after abdominal surgery – develops fever to 105. Must rule out? Could also be?

Answer 1

Wound infection from gas forming organism

Atelectasis (however, to cause such a high fever, patient would have massive collapse of entire lobe or entire lung)

Question 2

Clostridium infection can cause? Similar findings be seen in these types of infections?

Answer 2

1. Clostridial myositis
2. Gas gangrene

Multi organism infections (Streptococcus, Staphylococcus, Gram-negative rods)

Question 3

Postoperative patient S/P a large ventral hernia – history of smoking. Now coughing up yellow sputum. Differential? Smoking increases risk of developing? Management?

Answer 3

Atelectasis, bronchitis, pneumonia

Smokers have greater risk of developing bronchitis and pneumonia

1. CXR and ABG
2. Send for Gram stain and culture
3. If febrile, and CXR findings of pneumonia, treat with antibiotics before waiting for results of culture

Question 4

Postoperative patient S/P a large ventral hernia – history of smoking. Complains of hemoptysis – Ddx?

Answer 4

Malignancy, bronchitis, pneumonia, tuberculosis

1. If hemoptysis prior to hospitalization, malignancy most likely
2. If first episode, likely pulmonary embolus

Question 5

Postoperative patient S/P a large ventral hernia – history of smoking. Becomes acutely hypotensive with BP of 80/60 and O2 saturation drops from 95% to 85%– Suspected diagnosis? Management?

Answer 5

Massive PE or MI

1. Assess airway and rule out pneumothorax
2. Get CXR and EKG
3. If PE, initiate heparin