respiratory postop complications Flashcards
Question: What are the initial life-threatening conditions to identify in postoperative respiratory distress?
Answer: Tension pneumothorax, acute respiratory distress syndrome (ARDS), upper airway obstruction, and pulmonary embolism.
Question: What is the first step in assessing a patient with postoperative respiratory distress?
Answer: Evaluate their ABCDE (Airway, Breathing, Circulation, Disability, Exposure).
Question: What immediate actions should be taken if a patient with postoperative respiratory distress is unstable?
Answer: Stabilize the airway, provide supplemental oxygen, support with mechanical ventilation, obtain IV access, and monitor vitals.
Question: What are common signs and symptoms of postoperative respiratory distress?
Answer: Dyspnea, tachypnea, increased work of breathing, and hypoxemia.
Question: How is tension pneumothorax diagnosed and treated?
Answer: Diagnosis is clinical based on signs such as absent lung sounds, unequal breath sounds, hyperresonance to percussion, and tracheal deviation. Treatment includes needle decompression or tube thoracostomy.
Question: What are the typical findings in a patient with ARDS?
Answer: Severe hypoxemia, crackles on physical exam, and bilateral lung infiltrates on chest x-ray. ABG shows hypoxemia and either respiratory acidosis or alkalosis.
Question: What history might suggest upper airway obstruction in a postoperative patient?
Answer: History of difficult intubation, obesity, obstructive sleep apnea, anaphylaxis, or postoperative soft tissue swelling/hematoma. Surgeries involving the thyroid or parathyroid can also cause this.
Question: What are key signs of a pulmonary embolism in a postoperative patient?
Answer: Signs of respiratory collapse (hypoxemia, hyperventilation), and hemodynamic collapse (cyanosis, tachycardia, arrhythmias, hypotension). Diagnosis is confirmed with a CT angiogram showing filling defects in the pulmonary arteries.
Question: What is the most common cause of postoperative respiratory distress?
Answer: Atelectasis.
Question: How is atelectasis diagnosed?
Answer: Diagnosis is based on a history of cough, dyspnea, decreased chest expansion, shallow breathing, decreased breath sounds, and crackles on exam. Chest x-ray shows increased opacification, displacement of lung fissures, narrowing of intercostal spaces, or elevation of hemidiaphragm.
Question: What signs suggest pneumonia in a postoperative patient?
Answer: Fever on postoperative day five or later, pleuritic chest pain, productive cough, decreased breath sounds, rales, crackles, or rhonchi on exam. Chest x-ray shows a pulmonary consolidation or infiltrate.
Question: What findings are associated with pleural effusion?
Answer: Sharp inspiratory chest pain, dullness to percussion, decreased breath sounds, bibasilar crackles on auscultation, and blunting of the costophrenic angle on chest x-ray.
Question: What clinical signs are indicative of pulmonary edema?
Answer: Increased work of breathing, dullness to percussion, decreased breath sounds, and crackles on auscultation. Chest x-ray reveals diffuse pulmonary infiltrates.
Question: How can pulmonary edema be differentiated from ARDS?
Answer: Pulmonary edema related to heart failure shows similar signs and symptoms to ARDS but is treated with diuretics, which do not work in ARDS.
Question: What is the clinical presentation of aspiration pneumonitis?
Answer: Post-extubation dysphagia, choking, dry cough, fever, vomiting, decreased breath sounds, crackles, hypoxemia on ABG, and patchy infiltrates on chest x-ray.
