Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Multisystem > Perioperative Mx & Post Op Complications > Flashcards

Perioperative Mx & Post Op Complications Flashcards

1
Q

What is the approximate composition of a 70kg male?

A
  • Fat (15kg)
  • Protein (12kg)
  • Water (42kg)
  • Glycogen and minerals (1kg)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is total body water divided?

A

2 main compartments:

  • extracellular fluid 19L
  • intracellular (cytoplasmic) 23L
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is the ECF divided?

A

-Interstitial - 15L
-Intravascular (plasma) - 3L
-Third space (GIT/Renal) - ~1L
(may change if normal transcapillary exchange is interfered with e.g. inflammation).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the post-op hormonal response and its effect?

A

24-48h post op have increased cortisol, aldosterone and ADH secretion:

  • decreased renal Na excretion (therefore decreased water excretion to maintain osmolality)
  • increased renal K+ excretion (some results from tissue damage and breakdown of cells)
  • decreased renal water excretion (sml vol, high {} urine), independent of intake.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the aims of post op water and electrolyte therapy?

A
  • Maintenance needs
  • Replacement of pre-existing deficits
  • Replacement of ongoing losses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the maintenance requirements in 70kg male?

A

Water: 100mL/h (increased for fever)
Na: 75mmol/day
K+: 60mmol/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the common sites of ongoing post op fluid loss?

A
  • GIT: NGT aspirate or vomit, fistula, diarrhoea

- Third spacing: inflammation e.g. retroperitoneal effusion in pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How should ongoing fluid loss be assessed?

A

Recording of fluid balance, daily weights if possible.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How should measured upper GIT losses be replaced?

A

Isotonic sodium containing solutions (0.9% saline or Ringer’s lactate) supplemented with potassium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How should third space losses be replaced?

A

Not directly assessable. Replace with Ringer’s lactate solution.
Volume determined through clinical assessment of fluid balance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How are post op energy requirements determined?

A
  • Body weight (fat free mass)
  • Degree of surgical trauma
  • Sepsis
  • Nutritional status
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the energy requirement per kg body weight?

A

40cal/kg/day

Should be based on fat free mass (i.e. care not to overprescribe in obese or oedematous).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Factors contributing to poor post op respiratory function?

A
  • Preop res disease
  • Anaesthesia (PPV + Rx ==> may cause V/Q mismatch)
  • High FiO2 to correct low SaO2 ==>patchy collapse of alveoli due to decreased N content
  • Hypoventilation: pain, supine, decreased cough reflex, anaesthesia/analgesia.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What happens to the post op WCC?

A

Normally slightly increased for 2-3d post op; marked elevation during this period or prolonged elevation indicates infective/inflammatory process.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Routine post-op investigations?

A
  • BSL (diabetics)
  • Hb (24-36h post op)
  • WCC (if ?sepsis)
  • UEC (when fluids required)
  • ABGs (if ?resp insufficiency)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the effects of post op pain?

A
  • Decreased respiration (>hypoventilation/collapse)
  • GIT atony (ileus/N/V)
  • Bladder atony (retention)
  • Catecholamine release (vasoconstriction, increased blood viscosity, active clotting).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How are surgical wounds classified?

A
  • Clean
  • Clean-contaminated
  • Contaminated
  • Dirty
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the forms of peri-operative haemorrhage?

A
  • Primary: occurring during op
  • Reactionary: at conclusion of op with restoration of CO and BP –> dry wounds bleed
  • Secondary: days after op
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How can post op haemorrhage be identified?

A
  • Overt bleeding
  • Peripheral shutdown (mottling),
  • hypovolaemia (hypotension/ tachycardia/ tachypnoea/ decreased urine output.
  • Distension after abdo surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Causes of post op circulatory collapse?

A
  • Haemorrhage
  • Severe sepsis
  • MI
  • PE
  • Hypersensitivity reaction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Mx of post op haemorrhage?

A
  • Stop source (may need re-op)
  • Correct coagulopathy
  • Assess for transfusion need
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the clinical features of sepsis?

A
  • High pyrexia
  • Tachycardia
  • Hypotension
  • Warm periphery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the factors contributing to post op pulmonary complications?

A
  • Wound pain (esp upper abdo/chest)
  • Limitation of resp excursion
  • Ciliary paralysis
  • Drying of bronchial secretions
  • Oversedation
  • Obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the types of wound dehiscence?

A
  • Superficial and revealed (2/52 when sutures removed; skin and subcutaneous tissues separate; wound haematoma or cellulitis)
  • Deep and concealed (any time post op; all layers of abdo except skin separate = incisional hernia)
  • Complete and revealed (10/7 post op with protrusion of abdo contents).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Mx insulin in IDDM patients?

A

IV dextrose infusion and 0.5 normal insulin dose given morning of op.
Glucose throughout op guided by repeated BSL monitoring.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

5Ws of post op fever?

A
  • Wind: POD #1-2 (pulmonary atelectasis, pneumonia)
  • Water: POD #3-7 (urine - UTI)
  • Wound: POD #3-7
  • Walk: POD #8 (DVT/PE)
  • Wonder drugs: POD #1+ (drug fever)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Post op fever hours after surgery?

A
  • Inflammatory response to surgical trauma
  • Reaction to blood products received during surgery
  • Malignant hyperthermia
28
Q

Causes of POD#1 fever?

A

Acute:
-Atelectasis (most common!)
-Early wound infxn (esp Clostridium, GRPA Strep)
-Aspiration pneumonitis
Other: Addisonian crisis, Thyroid storm, transfusion rxn.

29
Q

Important Hx features in post op ward round?

A
  • Op and context in which it was performed
  • Is the pt feeling well?
  • Is the nutritional and fluid intake adequate?
  • Is there return or normal body function?
  • Is the analgesia adequate?
30
Q

Exam features in post op ward round?

A
  • Vital signs
  • Fluid balance
  • Output for drains / ?remove
  • Operative sites
31
Q

Ward round considerations re medications.

A
  1. VTE prophylaxis
  2. ?Cease: ABx, analgesics
  3. Other: ?analgesia, aperients, antiemetics, regular Rx
32
Q

Urine output to be maintained =?

A

> 30mL/hr or >1/2mL/kg/hr

33
Q

FLuid balance considerations D1 and D2 post op?

A

D1: increased ADH, do not give excessive fluids
D2: mobilisation often shifts fluid from interstitium back into intravascular space (decreased IVF in anticipation)

34
Q

Mx of low urine output?

A
  • If anuria, check for blocked IDC
  • Assess pt for hypovolemia
  • Ensure pt not bleeding
  • Give fluid challenge (500-1000mL stat crystalloid)
35
Q

Considerations in preventing post op complications?

A
  • Mobilisation: aim D2
  • Chest physio
  • VTE prophylaxis: mechanical and chemical
  • Adequate analgesia
  • Adequate nutrition and fluids
36
Q

Mx surgical wound infection?

A
  • ? open suture line
  • Drain underlying abscess
  • Swab for MCS
  • Heal by secondary intent
  • ABx
37
Q

When may superficial wound dehiscence occur?

A
  • If wound poorly apposed

- Suture /staples cut through

38
Q

What is deep wound dehiscence?

A

Burst abdomen due to dehiscence of fascial layer (sutures pulled through, slipped knot, poor tension).

39
Q

How does deep wound dehiscence appear on inspection?

A

Excessive haemoserous discharge from suture line or bowel on view.

40
Q

Mx deep wound dehiscenc?

A

Usually return to theatre; consider tension sutures.

41
Q

RFx for incisional hernia?

A

Poor wound healing, RFx:

  • poor nutrition
  • obesity
  • smoking
  • steroids
  • DM
  • ureamia
  • jaundice
  • infection
  • malignancy
  • tissue ischaemia
42
Q

How can surgical drains be classified?

A

Tubed v corrugated

Active v non-active

43
Q

Purpose of surgical drains?

A
  • Prevent collections from accumulating
  • Detect underlying complications
  • May be used to create controlled fistula
44
Q

Common drains?

A

Suction: Jackson Pratt, Redivac

Non suction: Penrose, Yate’s

45
Q

What is a T tube used for?

A

-After bile duct exploration

46
Q

When can T tube be removed?

A

Never before T tube cholangiogram (1/52)

47
Q

What is the role of an external ventricular drain?

A

-Relieves hydrocephalus
-Can check CSF pressure
Be very careful with it!!

48
Q

60y male D2 post total gastrectomy. UO 300mL in last 12h.
Input: 2L IV
Output: 1900mL various sources.
Management?

A
  • Check IDC
  • Fluid balance assessment
  • Ensure not bleeding
  • Give fluid! N Sal 1L over 2/24. Next bag over 4/24.
  • Review
49
Q

50yo male D4 post incisional hernia repair with finding of SBO. Now vomiting ++.
Possible causes?

A
  • Post op ileum
  • SBO
  • Ischaemic / infarcted SB
  • Gastric dilation
  • Drugs (narcotics)
50
Q

50yo male D4 post incisional hernia repair with finding of SBO. Now vomiting ++.
Management?

A
  • Antiemetics (maxolon, stemetil, ondansetron)
  • Place NGT: free drainage and aspirate
  • Give IVF (check fluid balance)
  • Order AXR (S & E)
51
Q

80y woman D2 post open cholecystectomy. Confused.

Possible causes?

A
  • Hypoxia: atelctasis, chest infection, over sedation, CCF, MI, PE
  • Sepsis: chest / urine / wound / intraabdo (bile leak)
  • Rx: opiates, sedatives
  • DTs
  • Metabolic: uraemia, hyponatremia, hypo-/-erglycemia
52
Q

Mx of post of confusion?

A
  • Hx (staff or family)
  • Turn on lights
  • Check Hx for pre op state, EtOH, drugs, diabetes
  • Check obs
  • Examine pt
  • Give O2
  • Ix: ABG, RBG, UEC, FBE, Blood cultures, MSU, CXR, ECG
53
Q

78y man 6h post abdominoperineal resection; lost 2L blood in theatre ==> 2xPRBC + 1500mL gelofusine. Epidural infusion in situ.
BP now 85/50.
What may be causing hTN?

A
  • Hypovolemia: bowel prep and fasted, long op, behind in fluid replacement, 3rd space loss, sepsis
  • Epidural causing peripheral vasodilation
  • MI or CCF
54
Q

78y man 6h post abdominoperineal resection; lost 2L blood in theatre ==> 2xPRBC + 1500mL gelofusine. Epidural infusion in situ.
BP now 85/50.
Mx?

A

-Decrease rate or cease epidural infusion
-Check FBE, UEC, ECG
-Give IVF +/- blood
(start N Sal 1L over 30min, R/V; may need gelofusine stat 500L if no response).
-If G-ve sepsis possible, give IVABx (3rd gen cep or stat gentamicin)

55
Q

What is a PICC line?

A
  • Inserted by radiology under U/S into basilic vein in upper arm
  • Use for TPN / other infusions
  • Risk of venous thrombosis of basilic vein
  • Can be used for weeks
56
Q

How is CVC inserted?

A

Into IJV or subclavian vein with tip in SVC.

Usually in theatre or recovery.

57
Q

How long can CVC remain in situ?

A

5-21d (ABx impregnated)

58
Q

CVC risks?

A
  • IMMEDIATE: Pneumothorax, arterial puncture, haematoma

- LATE: thrombosis, stenosis, sepsis

59
Q

What is vascath?

A

Temporary catheter used for haemodialysis. Inserted into IJV or femoral vein. NOT SUBCLAVIAN

60
Q

What is a permcath?

A

-Long term catheter for dialysis with dual lumen

61
Q

Where is permcath placed?

A

Placed in IJV or EJV

62
Q

Risks with permcath?

A

Infection and blockage

63
Q

What is the type / function of catheters used for chemotherapy?

A

Infusaport / Portocath
Buried port on chest wall with line into SVC. Placed under GA; used for long term central access for chemotherapy, IVD, blood taking.
-Less risk of infection

64
Q

What is the purpose of Hickman catheter?

A

Single or dual lumen catheter; tunnelled with cuff to prevent infection.
Used for chemotherapy, bone marrow infusion, blood transfusions, long term TPN.

65
Q

How should cuffed line be removed?

A
  • Use local anaesthetics
  • Cut down over cuff
  • Excise with line
  • Suture

Multisystem (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions