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Surgery > Postoperative Complications > Flashcards

Postoperative Complications Flashcards

1
Q

common post op complications

A

post op fever
pain
vomitting
low urine output
bleeding
chest pain
ileum
wound problems
constipation
diarrhoea/large stoma output

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2
Q

post op fever

A

practically every surgery patient will have a fever to some degree

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3
Q

hypothermia

A

beware the hypothermic patient post trauma or major surgery
just as concerning as high temp

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4
Q

fluctuations in temperature

A

body temp varies throughout the day due to normal metabolism
usually 36.5 at 06:00, and 37.5 at 20:00

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5
Q

key to management of post op fever

A

the time since surgery at which the fever occurs determines management

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6
Q

fever at day 0-2 is almost certainly due to

A

almost certainly due to Systemic inflammatory Response syndrome SIRS

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7
Q

what is SIRS and why does it happen 0-2 days post op

A

cell damage during surgery attracts macrophages and neutrophils which release various interleukins, cytokines, TNF; causing activation of clotting cascade, complement system, kallikrien-bradykinin system etc leading to massive increase in metabolic activity
interleukins act on the hypothalamus to resent the thermal set point - hence fever

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8
Q

usual post op temps due to SIRS

A

patients usually have post op temps of up to 38 for 1 to 2 days due to SIRS

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9
Q

management of fever at day 0-2

A

observe
administer paracetamol (po or IV)
do not give antibiotics or do blood cultures - no need

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10
Q

temp >40° at day 0

A

beware
could be malignant hyperpyrexia? rare
is an emergency - call anaesthetist
that with ice bath/slurry/IV fluids/Dantrolene

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11
Q

possible causes of fever at day 1-3

A

aspiration
Acute MI
PE

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12
Q

what to do if its aspiration

A

did they vomit during intubation?
do they have a post op ileus?

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13
Q

what kind of people might get an acute MI post op

A

elderly
pre operative IHD
post operative AF

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14
Q

why might they get a PE

A

innapprppriate prophylaxis
long operation
immobile

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15
Q

what might cause a fever post op day 4-7

A

consider post operative infections
wound, line sites, urine, internal collection/abscess

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16
Q

what to do if they have a fever day 4-7

A

check wounds - release sutures, swab, antibiotics, dressings
check line sites - remove, send for microscopy cultures and sensitivity (MCS), antibiotics
MCS urine
CT abdo, percutaneous drainage, antibiotics

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17
Q

spiking fever at day 7+

A

consider anastomotic leak, abscess/collection
resuscitate with fluids, nil by mouth, CT, antibiotics, consider theatre

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18
Q

temp above 36° at day 7+

A

beware
patient may be too unwell to mount a normal response

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19
Q

post op pain is usually managed by

A

acute pain team
(anaesthetists who review post ops daily)

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20
Q

types of pain management a patient may have after surgery

A

an epidural
patient controlled analgesia (PCA)
combined NSAID with Opiate for synergism

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21
Q

using combined NSAID and opiate

A

use regularly with stronger opiate for breakthrough pain, prn
add antiemetic prior to opiate

22
Q

what causes post op nausea and vomiting

A

analgesia
post op ileus

23
Q

how to give antiemetics for post op nausea and vomiting

A

give parenterally (not orally)
eg. maxalon, ondansetron

24
Q

if post op nausea and vomiting is severe

A

change opiate

25
Q

minimum urine output should be

A

0.5mls/kg/hour

26
Q

pre renal causes of low urine output

A

dehydration (under volumed)
haemorrhage
pump failure (eg. AMI, CCF)
vasodilation (epidural, sepsis)
abdominal compartment syndrome (low venous return)

27
Q

renal causes of low UO

A

ATN - drugs, ischaemia (clamping renal vessels)

28
Q

post renal causes of low urine output

A

retention due to drugs,
pain,
prostatism,
catheter problems (usually cause inability to void rather than low UO)

29
Q

most common cause of low UO

A

dehydration - but important to exclude haemorrhage

30
Q

assessment of a patient with low UO - history

A

feels thirsty, dizzy, unwell?

31
Q

assessment of a patient with low UO - examination

A

cool peripheries, tachycardic, tachypnoeic, hypotensive, check wound, abdo distension, other swellings, drains, check fluids given in theatre

32
Q

investigation for patient with low UO

A

bladder scan
check FBC (? coags) if bleeding suspected

33
Q

a haemorrhage may be

A

primary (intraoperative)
reactionary (post op when BP increases or clip/ti slips)
secondary (several days later due to infection)

34
Q

if haemorrhage is obviously from a wound

A

apply pressure or insert suture
reassess in 1-2 hours
beware there could be massive intra-abdominal bleed that is welling up through the wound

35
Q

class 1 blood loss

A

<750ml
obs normal

36
Q

class 2 blood loss

A

750-1500ml
HR100-120
BP normal
RR 20-30
UO 20-30

37
Q

class 3 blood loss

A

1500-2000ml
HHR 120-140
BP reduced
RR 30-35 UO 5-15
anxious

38
Q

class 4 blood loss

A

> 2000ml
HR > 140 BP reduced
RR > 35
UO nil
confused

39
Q

is low BP due to blood loss a big deal

A

yes

40
Q

paralytic ileus

A

disruption of normal small bowel motility from non mechanical causes
occurs in post op patients

41
Q

aetiology of paralytic ileus

A

immobility
low potassium or magnesium
sepsis

42
Q

symptoms of paralytic ileus

A

bloating, abdo discomfort, nausea and vomiting

43
Q

signs of paralytic ileus

A

dehydration, abdo distension, absent bowel sounds

44
Q

investigation of paralytic ileus

A

blood test to exclude sepsis and dehydration
consider imaging to exclude sepsis

45
Q

treatment of paralytic ileus

A

nasogastric tube, IV fluids, treat underlying cause

46
Q

symptoms of wound infection

A

erythema, swelling, pain, fever, discharge

47
Q

wound infection is usually due to

A

patients own skin flora and bowel contents

48
Q

management of wound infection

A

swab MCS
remove clips/sutures
open, decried slough, irrigate, pack
involve wound specialist nurse
start antibiotics

49
Q

wound dehiscence classification

A

superficial - skin
deep - muscle and fascial layers only, skin intact
full thickness - all layers open

50
Q

superficial wound dehiscence is managed by

A

dressings only
you can resuture if clean and recognised early

51
Q

deep wound dehiscence manifests as

A

early hernia
requires take back to theatre and resuture
semi urgent

52
Q

full thickness dehiscence requires

A

urgent theatre

Surgery (18 decks)

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