13: Post-Op Fever - Bennett Flashcards Preview

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Flashcards in 13: Post-Op Fever - Bennett Deck (17)
1

life threatening elevation in body temperature

malignant hyperthermia

-1/12,000 pediatric anesthetics
-1/40,000 adult anesthetics

2

etiology of malignant hyperthermia

- inhalation of general anesthetics (halothane)
- combination of muscle relaxants (succinylcholine)

3

theory behind malignant hypothermia

- Sarcoplasmic reticulum contains approx. 3000 times the amount of calcium normally found in the sarcoplasm.
- Normal muscle contraction and relaxation involves the release and resequester of calcium.
- In malignant hyperthermia, the resequester of calcium does not occur.

4

s/s malignant hyperthermia

- Arrythmias
- masseter muscle spasm
- Fever with increased body temp.
- tachypnea and tachycardia
- profuse hyperhydrosis
- metabolic and respiratory acidosis
- hyperkalemia
- abnormal ECG
- elevated CPK

5

non-pharmacological tx malignant hyperthermia

- Stop administration of anesthesia
- Change tubing
- Hyperventilate with 100% o2
- Correction of acidosis
- Cool the patient

6

medication for malignant hyperthermia

DANTROLENE
-- Intra-op 1mg/kg rapid IV push until symptoms subside
-- max dose 10mg/kg
-- post crisis 4-8 mg/kg/day po in 4 doses 1-3 days

7

pre-op prophylaxis malignant hyperthermia

4-8 mg/kg/day po in 4 divided doses
1-2 days preop and last dose 3-4 hrs. pre-op.
Dantrium IV 2.5 mg/kg 1 Hr pre-op

8

body temp ________ during post op period is significant

greater than 100.4 F/ 38 C

9

two causes intraop fever

heat pyrexia or malignant hyperthermia

10

describe heat pyrexia

- occurs during surgery and up to 1 hr post op
- caused by trauma of procedure resulting in inflammation [pyrogenic cytokines]
- increased permeability
- act on anterior hypothalamus and case release of prostaglandins

11

********** Post Op Fever
1-2 d
2-3 d
3-7 d
5-7 d
greater than 7 d

1-2 d = Wind = atelectasis

2-3 d = Water = UTI (or constipation or hematoma)

3-7 d = Wound = infection

5-7 d = Walking = DVT/thrombophlebitis

7+ = Wonder = Drug Fever

12

mediastinum deviates to ______ lung on CXR with atelectasis

affected

13

anytime fever

drug fever
catheter fever
rxn to blood transfusion

14

emergent causes of early post-op fever

- necrotizing STI/myonecrosis
- PE
- alcohol withdrawal
- adrenal insufficiency
- malignant hyperthermia

15

long v. short duration post op edema

short = duration (15-30min.) caused by factors that increase permeability. (serotonin, kinins, prostoglandins)

long = duration (1-2 days) from leakage caused by direct injury. (endothelial destruction)

16

s/s anaerobic infection

- intense pain
- foul smelling
- gas
- necrosis
- brown/black discharge

17

tx infection post op

-decompression
-drainage
-debridement
-antibiotics

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