Test 2 Surgical Specific Care Flashcards
Most common Cardiac Related Complication post
Throracic Surgery
Afib
Self limited
BB +CC+Amiodarone
New onset Afib post
Esophagectomy
Consern for
**anastomotic Leak **
Work up for Afib
EKG
Cardiac Enzymes
EArly mobility
Chest Physiotherapy
Chest Tube Management
- 20 mm Hg LWS for 24 to 48 hrs
No persisitent leak
H2O seal
CXR without: significan pneumothorax or pleural effusion : Remove tube
Pneumthrorax: Accumulation of air in the pleaural space, causing lung collapse
**Pleural effusion: **
Prologed Air Leak
Increase risk of PNA or Empyema
**Emphyema: ** pus; filled infection of pleural space
TX: Pleurodosis or
re-operation for repair.
Surgery: Vascular
- **High Incidence CAD **
**50 to 70 % ischemic heart disease
30 to 50% previous myocardial infarction**
Vascular :
**Primary cause of death of major vascular procedures
Due to what ?
Perioperative Myocardial Ischemia
Due to :
Increase O2 demands,
Pain
Hypotension and Tachycardia
Myocardial Ischemia
Plaque rupture
Vasular
AKI
- Pre-existing renal disease
- rediologic contrast administration
- suprarenal aotic clamping
- Acute blood loos anemia
- Vaspressor (clamping down )
Vasuclar surgery
post up management
Pain control
Hemodynamic monitoring
Continue BB and STatin therapy
Crystalloid resuscitation
blood products
Avoid nephrotic agents
Surgery Specific CAre :
Abdominal
Complications ?
Sepsis
Hemorrhage
Respitory Failure
Abdomial Intraabdominal Sepsis
tX
Vancomycin
Zosyn or hight Cephlosporin (3rd G ceftriaxone )
Microfungial anti fungal
for 7 days per ID
Isotonic Crystollodi IV F
MAP >65 UO 0.5
Abdominal surgeries
Most common Bacteria
- Ecoli (Gram -)
- Enterococcus (gram + )
Liver Transplant
ICU adminssion
Patiet very Confusion
Common Cause of Death : Infection
liver Transplan
Re-Exploration
control Coagulation and Thrombocytopenia
Hemodynamically stable
No compartment syndrome
Early Liver Transplantation Dysfunction
Elevated Liver Serum Enzymes
Few days post up
Technial Errors during surgery
Doppler US liver
Liver
Infetion
Blunted S/s (no s/s of typical Infection)
**Early Infection : R/t biliary anastomosis leak
ABX: Gram (-) gram (+) MRSA + Fungal
First six month:Bactrim and Ganciclovir
Acute Regjection
- 6 to 8 wks after tranplantation
- occurs because cell mediateer attack on liver
- S/S: fatique, low grade fever, Elevated Transaminase lievel
Acute Rejection
Prevention and Treatment
Prednisone
Calcineurin Inhibitors
Antimatebolite
Hyper Acute Rejection (HAR)
Rare
Due to ABO crossmatch issuies
Occurs whithin few hours of transplant
**S/S: **elevated billirubin, Encephalophathy, Weakness, thrombocytopenia, coagulapathy, fever, hypotension
HAR DX
**Doppler US: **
Portal vein thrombosis
Absence of biliary duct obstruction
Calcitronin Inhibitors
TAcrolimus
Cyclosporine
Pimeclolimus
