Test 18 - Surgery Flashcards
Most common postop complication
Atelectasis - radiograph shows loss of lug volume due to loss of collapse of lung tissue
Signs and Symptoms of Atelectasis
Symptoms: Shallow breathing and weak cough 2-3 days after thoracic or abdominal surgery.
Signs: Low O2, Low CO2, high pH
MOA: shallow inhalations result in low recruitment of alveoli resulting in LOW O2. This increases respiratory drive resulting in LOW CO2. This causes respiratory alkalosis resulting in HIGH pH
Treatment of Atelectasis
Supportive care. Maintain pain control, deep breathing exercises and incentive spirometry.
73 yo man comes to ER with pain in left hip. He fell.
PMH: shortness of breath, cough, decreased breath sounds and palpitations last few days. HTN, T2DM, COPD, BPH. Physical exam shows shortened and and externally rotated LLE. Xray shows L femur neck fracture. He is tachy, RR24, BP good. What needs to happen next?
- Establish that the patient is stable for surgery.
- did he fall b/c of a syncopal episode?
- does he have Afib?
- does he have a PE (decreased breath sounds)
- does he have pneumonia (cough, SOB) - CXR, EKG, cardiac markers will be able to tell us a lot more. Need them before surgery.
- Surgery (can be delayed up to 72 h to address stability)
Femoral nerve innverates?
Motor: anterior compartments of the thigh (knee extension and hip flexion)
Sensory: sensation to anterior thigh and medial leg via saphenous branch
Tibial nerve innervates?
Posterior compartment on the thigh. Plantar muscles of the foot. Flexion of the knee and toes. Rest of sensation to the leg.
Obturator nerve innervates?
medial compartment of the thigh. Adduction of the thigh. sensation over medial thigh.
Fibular nerve innervates?
aka common peroneal nerve
muscles of the anterior and lateral leg
sensation to the anterolateral leg and dorsum of the foot
