Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Musculoskeletal > SA MS 11: Post Op Complications > Flashcards

SA MS 11: Post Op Complications Flashcards

1
Q

Sx Complications

A 
Pain
IFX
Hemorrhage
Dehiscence 
Implant failure
Neuropraxia 
Non-union/malunion
Fx
Seroma
Ax complications --> aspiration pneumonia, sudden death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pain

A

Assessment
Combine opioids and NSAIDS esp early post op
Pre-emotive strike –> treat pain BEFORE starts
–don’t forget about local analgesia: epidurals, nerve blocs
If in doubt, treat!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Opioids

A 
Fentanyl - patches or CRI
Hydromorphone 
Methadone 
Oxymorphone 
Morphine 
Buprenorphone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Other Pain Meds

A

Tramadol
Gabapetin/pregabalin
Amantadine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

NSAIDS

A 
Rimadyl 
Metacam (meloxicam)
Deramaxx (deracoxib)
Previcox 
Onsior (Robenacoxib)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Sources of Sx IFX

A

Pre-op
Intra-op: gloves, suction tips, instruments, implants
Post-op: dog licks incision, inappropriate confinement
Hematogenous: dental, UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Sx IFX Location

A

ST
Jt
Implant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Acute Sx IFX

A

Within days after sx
Usually DT intraop contamination
Patient licking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Chronic Sx IFX

A

Months to years later
Intra-op or other source
May have hx of skin dz, mild incisional issues, etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

CS IFX: Acute

A

Usually takes 3-5d to manifest

  • -pyrexia
  • -CBC changes
  • -Heat, swelling, painful incision

What else can cause post-op pyrexia?

  • -IFM
  • -Drugs (cats)
  • -Catheter issues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CS Chronic IFX

A

Can take up to 2yr to manifest
Draining tracts - usually distal to implant
RAD evidence of implant loosening
Chronic lameness

CS resolved temporarily if appropriate abx admin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Culture and Susceptibility

A

Get a good culture of ANY d/c prior to ABX admin
–try not to culture skin
Esp if:
–consistency changes
–new draining occurs and any time post-op
–draining tract develop, esp distal to previous sx site
–permanent implant present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

IFX Tx if after bone healing has occurred

A

Remove implant
Culture
2-4 weeks appropriate ABX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

IFX Tx if bone healing has not occurred

A

Culture draining tract
Put on appropriate ABX
–if incisional and no evidence of implant involvement - 2-4wks
–if implant involvement and osteomyelitis - until bone healed (up to months)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Dehiscence

A 
Secondary to IFX or IFM
Make sure P wear an e-collar!
Activity restriction 
Tx -- sx explore vs second intention healing 
Systemic complications: sepsis, DM, etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Implant failure Causes

A

Successful fx healing = race b/c implant can survive only certain amt of force or number of cycles (steps)

Implant selection or post-op care
--fracture malalignment 
--screw pullout
--pin migration
--catastrophic failure 
IFX
Systemic dz 
Local bone pathology
17
Q

Implant Failure Tx

A

Depends on:

  • -how soon after sx/how stable is fracture?
  • —acute post-op usually treated more aggressively
  • —implant revision often req’d
  • -degree of failure - bent plate or catastrophic failure?

Implant failure noted on recheck RADS without CS usually don’t req sx intervention

18
Q

Delayed union

A

Prolongation in time for fracture healing - assumes eventual healing

19
Q

Nonunion

A

Frx failing to progress to osteosynthesis regardless of healing time

20
Q

Malunion

A

Result of failure of mechanical reestablishment of the form and function of the fx in which healing still occurs

21
Q

Seroma

A

-fluid accumulates beneath the skin or btw fascia planes
-result of dead space
-tx’d with warm packing - 5-10 min 3-4x/d
Monitoring for:
–increased redness, heat, pain, size
Common complication

22
Q

Ax Complications

A 
Death
Aspiration pneumonia 
Peripheral nerve block - temp or permanent LOF 
Epidural 
--neurologic consequences
--urinary retention 
--epidural abscess 
Positional neuropraxia
23
Q

Client communication: complication management starts PRE op

A

Spend time in consult reviewing potential complications

Est form should have potential complications in writing

If O unsure, give them time

24
Q

Pre-Sx prep

A

Pre-op checklist with stopping pets

Mark the correct limb to be operated on

25
Q

IO Complications - implant

A

Screw stripping
Inadequate plate contouring
If fx IA

26
Q

IO Complications - inadvertent damage

A

Cut lrg BV, nerve, tendon

Cut wrong bone/side

27
Q

IO Complications: biologic

A

Fx propagation
Ax complications
Contamination

28
Q

IO Complications

A

Take post-op rads while P still under ax

Go back to sx NOW - far easier than later

29
Q

Pros of Post-Op bandages

A 
Provide implant support
Minimize swelling 
Protect sx site 
Cover drain sites 
Need changing and care
30
Q

Cons of Post-Op Bandages

A

Difficult to ice around
Can get bandage sores
Slippage
Turn into GI FB

31
Q

Robert Jones

A

Primary layer = telfa, non-adherent
Secondary layer = rolled cotton, cast padding
Tertiary layer = clin, can strangulate if too tight
Outer layer = vet wrap (self adherent)

32
Q

Bandage Complications

A 
Pressure sores 
Slippage
Strikethrough 
Tourniquets 
Damp or dirty
33
Q

Cold Therapy

A 
Cold compress 
For first 24-48hrs after sx 
VC
Applied to skin with minimal barrier 
Perform while swelling increasing 
Decreases pain
34
Q

Heat Therapy

A

Once swelling has peaked or if have a development of a seroma
VD of lymphatics to decrease swelling
Apply for 5-10min 2-4x/day
Be sure not too warm - burns!

35
Q

What to use when?

A

Heat Therapy: before exercise, massage or stretching exercises
Cold: after exercise to minimize IFM and pain

36
Q

Dx Post Op Complications

A

PE - hands and eyes on P!
–cannot make dx over the phone
Local/limb vs systemic complications based on presenting complaint

37
Q

Systemic Post-Op complications: R/O

A

Incision Problems
Meds +/- start protective meds
Additional dxs
Blood tests and further imaging warranted

38
Q

Local Post Op Complications

A

Lameness can be failure to improve or acute worsening
–incision site may be concurrent issue
RADS ARE NEVER A WRONG CHOICE!

39
Q

Key Points

A

Be honest with owners
Understand the sx px
Know common sx complications
Know when to recheck and what the expectations are at each recheck

Musculoskeletal (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions