OnlineMedEd: Surgery: General - "Other Postop Issues" Flashcards
Review the workup of postop chest pain.
Must rule out MI and PE:
- MI: do an ECG and troponins
- PE: US and CTA
How is MI management different in a postop patient?
You cannot use tPA because they just had surgery, so you must use PCI and heparin.
Give a differential for postop AMS.
•Electrolyte imbalance (commonly in sodium or calcium)
–get a BMP and give fluids
•Sundowning
–antipsychotics
•Hypoxemia (PE, ARDS, PNA)
–Disease-specific
• DTs
–Give benzos
How should you work up urinary retention postop?
•Evaluate those making less than 0.5 ml/cc/hr.
-If they have the urge to go but cannot, do an in-and-out catheter for presumed obstruction.
- If they do not have the urge but they are making some urine, give them a 500 cc bolus (for presumed mild AKI). If this does not correct it, then proceed to evaluate for intrinsic etiologies of AKI.
- If they do not have the urge and they have made no urine, check the catheter for a kink.
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Ileus presents with ________________.
dilation of the entire bowel: small and large
How can you treat ileus?
- IVF
- Potassium
- Moving around
How can you differentiate ileus and obstruction?
X-ray
KUB shows uniform dilation of the entire bowels while obstruction shows dilations up to a point and then shrunken bowel after.
Describe the management of dehiscence.
- Diagnosed clinically: skin and subcutaneous breakdown with leakage of serosanguinous fluid
- Binders
- Avoid straining
- Reoperate (electively) to close the wound
How should you handle eviscerations?
- Warm saline dressings
- OR emergently
- Do not push it back in immediately –doing this without washing it out will cause infections
What do you need to rule out in postop fistulas?
Think of a FETID fistula: •Foreign body • Epithelialization •Tumor •Inflammation / IBD / Irradiation •Distal obstruction
