Postoperative Care Flashcards
What is post-op fluid management?
Replace blood lost during surgery + provide maintenance IVF + make up for fluid loss in drains/NG tubes/fistulas
How do you replace surgical blood loss?
Replace in a 3:1 ratio with IVF
How do you replace maintenance IVF?
Administer D5 1/2 NS + KCl using the 100/50/20 rule for daily fluid requirements, or the 4/2/1 rule for hourly fluids
What is the third space?
Fluid sequestered into ISF due to inflammation or injury, mobilized 3-5 days after recovery –> requires decrease in IVF rate
What is malignant hyperthermia?
T>104 following anesthesia with high risk of myoglobinuria; tx dantrolene, 100% oxygen, and cooling blankets
What is bacteremia?
T>104 and chills within 1 hour or an invasive procedure; get blood Cx x3 and start empiric abx
What are the complications of aspiration?
Complication of awake intubations; leads to sudden death, chemical pneumonitis, or secondary pneumonia
How do you manage aspiration?
Prevent via NPO and antacids before intubating, Tx BAL and bronchodilators
How do you manage a tension pneumothorax?
Complication of intubation in weak or traumatized lungs, presents as “difficult to bag”, progressive hypotension and JVD; Tx is emergent needle decompression + chest tube
What is normal urine output post-op?
At least 0.5-1 mL/h/kg
What is post-op urine retention?
Presents as a need to void, but inability to do so; Tx is straight cath at 6 hours post-op and Foley after 2nd straight cath
UOP = 0 is likely due to a kinked or plugged Foley
UOP < 0.5 is either due to fluid deficit or acute renal failure; give a bolus of 500 mL IVF and if UOP responds, then it’s due to a fluid deficit
What are the potential causes of post-op hematuria?
Consider bladder overdistention, cancer, infection, kidney stones, trauma, prostatitis, and cyclophosphamide; get urology consult
What do you consider with post-op fever?
Consider the five W's: Wind (atelectasis POD 1) Water (UTI POD 3) Walking (DVT POD 5) Wound infection (POD 7) Wonder Drug (drug-induced fever)
How do you treat post-op atelectasis?
Partial lung collapse, dx bilateral inspiratory crackles, prevent with pulmonary toilet and incentive spirometry
Can develop into pneumonia POD 3 if left untreated
What is urosepsis?
UTI + septic shock; presents as cloudy urine, fever, hypotension, and a change in mental status; dx by urinalysis and urine Cx, tx with empiric abx + IVF
How do you treat a wound infection?
Dx examine wound site for erythema and fluctuance; if cellulitis –> abx only
if abscess –> drain pus and BID dressing changes
What is suppurative phlebitis?
Infected thrombus at site of venipuncture; Tx is to remove catheter and surgical excision of infected vein to the first non-infected branch, leave wound open, and give IV abx
How do you treat a GI fistula?
GI fistula causes leakage of GI contents from wound site; tx is NPO, TPN, and protect abdominal wall until body can heal itself
What prevents the healing of a fistula?
FRIEND: foreign body, radiation, infection, epithelialization, neoplasm, distal obstruction
Fistula x peritonitis = requires surgical exploration
Fistula x abscess = percutaneous drainage
Post-op chest pain concerns
MI : presents as acute chest pain +/- other classic signs; Dx CK-MB or troponin I, treat the complications
PE: presents as chest pain, hypoxia, and prominent JVD; Dx is V/Q scan, Tx is heparin –> IVC filter if PE recur while anticoagulated
How do you treat ARDS?
Presents as hypoxia due to septic shock
Tx intubation with high PEEP and permissive hypercarbia, then look for source of sepsis
When do you see delirium tremens?
Presents as hallucinations in an alcoholic POD 2-3, prevention is key and tx is controversial
What is hepatic encephalopathy?
Presents as coma in a liver failure patient s/p TIPS due to ammonia toxicity
How does wound dehiscence present?
Presents as salmon-colored fluid soaking dressings s/p open laparotomy POD 5; stabilize wound site, surgical closure at a later date
