Post Operative Complications

Question 1

Who is at risk of complications?

Answer 1

Poor nutritional state
Inflammatory state
Organ failure
Compromised immunity
Vascular disease
Elderly, smoking, DM, obesity
dementia
Patients not fully optimised pre-operatively

Question 2

What is involved in post-op care?

Answer 2

Monitoring = vitals, fluid balance
Wounds/stomas/drains
Monitor blood results
Medication review = VTE proph, AB, analgesia
Nutrition
Physiotherapy
Enhanced recovery

Question 3

Classifying post-op complications

Answer 3

General
Specific to type of surgery
Related to pre-existing co-morbidities = CV/Resp pathologies

Question 4

General complications of surgery

Answer 4

Haemorrhage
SIRS
VTE
Wound complications and surgical site infections

Question 5

Examples of complications to specific surgeries

Answer 5

Anastomotic leak in visceral surgery
Infected prosthetic materials
Dysfunction of operated organ - transplanted

Question 6

How else to classify complications?

Answer 6

Immediate
Early
Late

Question 7

Immediate complications

Answer 7

Airway obstruction
Reactive haemorrhage
Acute pneumothorax

Question 8

Early complications

Answer 8

Acute cerebrovascular event
Acute MI
Pyrexia due to atelectasis
Post op urinary retention
Renal impairment

Question 9

Late complications

Answer 9

Chest/wound/urinary infection
Secondary haemorrhage
DVT/PE

Question 10

Scoring systemcs

Answer 10

PARS - patient at risk score
MEWS - modified early warning score
NEWS - national
NEWS2

Question 11

What is NEWS2 based on?

Answer 11

RR
Ox sats
Systolic BP
HR
Level of consciousness/new confusion - AVPU or new CA
Temp.

Question 12

How does a MEWS work?

Answer 12

4,3,2,1,0,1,2,3,4
<2 = qualified nurse review patient at next hand over
2-3 = qualified nurse to review immediately and repeat obs and start therapy
4-5 = 2-3 actions + junior doctor to review within 30 minutes
6-7 = 2-3 actions + urgent review by SHO or StR immediately + inform critical care outreach team of
8 = 2 + urgent SHO or StR immediate review + urgent medical emergency Team review

Question 13

AVPU

Answer 13

Alert
Only responds to voice
Only response to pain
Unresponsive

Question 14

CA

Answer 14

C = confusion
A = agitation

Alternative for AVPU

Question 15

Definition of SIRS

Answer 15

2 off
- temp equal or above 38 or below 36
- HR >90
- resp >20 or PaCo2 <32
WBC >12 or <4

Question 16

Define Sepsis

Answer 16

SIRS + infection

Question 17

Define severe sepsis

Answer 17

Sepsis associated with organ dysfunction, systemic hypoperfusion or hypotension

Question 18

Define septic shock

Answer 18

Sepsis with arterial hypotension despite adequate fluid replacement

Question 19

qSOFA screening tool

Answer 19

RR 22 or greater
Altered mentation = GCS <15
Systolic BP 100 or less

2 of the above
EWS is better

Question 20

Red Flag Sepsis - what is it?

Answer 20

Based on EWS
UK sepsis trust & NHS England
Also used in community - GP’s = can call 999
Ensures hospital staff use sepsis 6 ASAP

Question 21

Red Flag Sepsis Criteria

Answer 21

1 of

• AVPU - V, P or U
• Acute confusion
• RR 25 or greater
• Need oxygen to keep SpO2 92 or higher, 88 in COPD
• HR >130
• Systolic BP 90 or below, or >40 drop from normal
• not passed urine in last 18h or <0.5ml/kg/hr
• non blanching rash/mottled/ashen/cyanotic
• recent chemo in last 6 weeks

Question 22

Sepsis 6

Answer 22

Give
- oxygen
- AB
- fluid
Take
- cultures
- bloods for lactate
- UO