SA MS 11: Post Op Complications Flashcards
Sx Complications
Pain IFX Hemorrhage Dehiscence Implant failure Neuropraxia Non-union/malunion Fx Seroma Ax complications --> aspiration pneumonia, sudden death
Pain
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!
Opioids
Fentanyl - patches or CRI Hydromorphone Methadone Oxymorphone Morphine Buprenorphone
Other Pain Meds
Tramadol
Gabapetin/pregabalin
Amantadine
NSAIDS
Rimadyl Metacam (meloxicam) Deramaxx (deracoxib) Previcox Onsior (Robenacoxib)
Sources of Sx IFX
Pre-op
Intra-op: gloves, suction tips, instruments, implants
Post-op: dog licks incision, inappropriate confinement
Hematogenous: dental, UTI
Sx IFX Location
ST
Jt
Implant
Acute Sx IFX
Within days after sx
Usually DT intraop contamination
Patient licking
Chronic Sx IFX
Months to years later
Intra-op or other source
May have hx of skin dz, mild incisional issues, etc
CS IFX: Acute
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
CS Chronic IFX
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
Culture and Susceptibility
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
IFX Tx if after bone healing has occurred
Remove implant
Culture
2-4 weeks appropriate ABX
IFX Tx if bone healing has not occurred
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)
Dehiscence
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
Implant failure Causes
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
Implant Failure Tx
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
Delayed union
Prolongation in time for fracture healing - assumes eventual healing
Nonunion
Frx failing to progress to osteosynthesis regardless of healing time
Malunion
Result of failure of mechanical reestablishment of the form and function of the fx in which healing still occurs
Seroma
-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
Ax Complications
Death Aspiration pneumonia Peripheral nerve block - temp or permanent LOF Epidural --neurologic consequences --urinary retention --epidural abscess Positional neuropraxia
Client communication: complication management starts PRE op
Spend time in consult reviewing potential complications
Est form should have potential complications in writing
If O unsure, give them time
Pre-Sx prep
Pre-op checklist with stopping pets
Mark the correct limb to be operated on
IO Complications - implant
Screw stripping
Inadequate plate contouring
If fx IA
IO Complications - inadvertent damage
Cut lrg BV, nerve, tendon
Cut wrong bone/side
IO Complications: biologic
Fx propagation
Ax complications
Contamination
IO Complications
Take post-op rads while P still under ax
Go back to sx NOW - far easier than later
Pros of Post-Op bandages
Provide implant support Minimize swelling Protect sx site Cover drain sites Need changing and care
Cons of Post-Op Bandages
Difficult to ice around
Can get bandage sores
Slippage
Turn into GI FB
Robert Jones
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)
Bandage Complications
Pressure sores Slippage Strikethrough Tourniquets Damp or dirty
Cold Therapy
Cold compress For first 24-48hrs after sx VC Applied to skin with minimal barrier Perform while swelling increasing Decreases pain
Heat Therapy
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!
What to use when?
Heat Therapy: before exercise, massage or stretching exercises
Cold: after exercise to minimize IFM and pain
Dx Post Op Complications
PE - hands and eyes on P!
–cannot make dx over the phone
Local/limb vs systemic complications based on presenting complaint
Systemic Post-Op complications: R/O
Incision Problems
Meds +/- start protective meds
Additional dxs
Blood tests and further imaging warranted
Local Post Op Complications
Lameness can be failure to improve or acute worsening
–incision site may be concurrent issue
RADS ARE NEVER A WRONG CHOICE!
Key Points
Be honest with owners
Understand the sx px
Know common sx complications
Know when to recheck and what the expectations are at each recheck
