Exam 3 Surgical Complications Flashcards Preview

Q4 EM Surg > Exam 3 Surgical Complications > Flashcards

Flashcards in Exam 3 Surgical Complications Deck (34):
1

Post Op Fever prevalence?

2/3 of pts

2

Post Op Fever caused by?

Bacteria/toxins-induces cytokines
Trauma-induced cytokines

3

Cytokines induce?

Pro-inflammatory response

4

Causes of Post-Op fevers? 7 W's

Wind = PNA, atelectasis
Water = UTI
Wound
Waste = Low GI (leak/bacteria)
Walk = DVT/PE
Wonder Why = Abscess
Weird drugs = Meds

5

Post Op fevers: W/U when?

Fever presents > 48 hrs post
Temp > 102

6

Post Op fevers: W/U should include? (5)

Examine the pt!
CBC w/ diff
UA w/ Cx
Blood Cx
CXR

7

Atelectasis U result of?

U where in lung?

Causes fever when?

Tx?

Thoracic/Up abd surg
General anesth

Base/segmented

Most C cause of fever w/i 1st 48 hrs

Early ambulation, spiro, cough, chest physio

8

PNA U result of? (3)

W/U? (3)

Tx?

Atelectasis
Aspiration
Mechanical vent

CXR, sputum cx, CBC

ABX

9

Aspiration C when?

Prevent how? (3)

Old
NG tube

Elevate head
NG suction
Nasotrach suction

10

Causes of fever POD 3+?

Wind
Water
Wound
Waste
Walk
Wonder Why
Weird drugs

Wind = PE
Water = UTI
Wound = wound or IV catheter
Waste
Walk = DVT
Wonder Why = Abd/Rectal abscess
Weird drugs = Meds

New/unrelated dz

11

UTI risk factors?

In cath, esp > 2 days
Urine retention/stasis

12

Seroma is?

C w/?

Benign collection of liquified fat, serum, lymph in SQ under wound

Large skin flaps

13

Seroma presentation? (3)

Localized/circumscribed swelling
Pressure/discomfort
Occasional drain clear/yellow

14

Seroma tx? (3)

Suction drain
Aspiration
I&D

15

Hematoma is?

Why do we care?

Abn collection of blood
U in SQ of wound or abd cavity

Potential 2° infection

16

Hematoma caused by? (3)

Tx?

Inadequate hemostasis
Depleted clotting factors
Coagulopathy

Fix cause
Evacuate

17

Dehiscence is?

Why do we care?

Postop separation of abd layers

Risk of evisceration (disembowelment)

18

Dehiscence most C when?

P causes of dehis?

7-10 days post (upto 20 days)

Hematoma
Infection

19

Dehiscence presentation? (2)

Sudden/dramatic drain of large vol of salmon-colored fluid

P ripping sensation

20

Dehiscence tx?

Depends on extent
Wound care to OR

21

Wound infection most C when?

POD 3-7
POD 2-3 if Strep A or c diff

22

Wound infection tx? (5)

I&D if fascia intact
Wet-to-dry or Silver alginate dressings
Wound vac
Cx
ABX

23

C. Diff U seen when?

Presentation?

Test?

w/i 72 hrs post

Watery, smelly D

Stool cx for toxin

24

Intra-Abdominal infections U caused by?

Presentation? (5)

Tests? (3)

Complication (dehiscence)

Abd pain, fever, leukocytosis, tachy, look sick

CXR (free air)
CT
US

25

Intra-Abdominal infections U result of what microbes? (3)

E. Coli
Enterobact
Bacteroides

26

Intra-Abdominal infections mgmt? (5)

Laparotomy
I&D
PerQ drain
Debridement
ABX

27

What classes of meds may cause post-op fevers?

ABX
Cardiovascular
Anticonvulsants
Bunch of other stuff

See slide 74

28

Bacteremia cxs must be from?

two different sites

29

Bacteremia mgmt? (4)

New IV line Q 3 days
Seal IV lines
ABX
If suppurative (puss-filled), I&D of vein by vascular doc

30

Decubiti are?

U seen where? (4)

Pressure sores

Sacrum
Occiput
Ischia
Heels

31

Decubiti grades

I?

II?

III?

IV?

I = Non-blanching erythema of intact skin

II = Superficial, part thickness loss of epiderm and/or derm

III = Full thick loss w/ SQ fat necrosis, P extension to fasica

IV = Full thick loss w/ necrosis of mm, tendon, bone

32

Decubiti mgmt?

PREVENTION
Debride/freq changes
Wound vac

33

Abscess mgmt?

Aspiration
P I&D

34

I&D indicated for?

Done how? (5)

Relief of pain/infection

Open w/ 11# blade
Evacuate
Irrigate
Pack
Systemic ABX