Edwards 3-28-08 Surgical Complications

Front 1

Clear yellow fluid in subcutaneous space

Back 1

Seroma

Front 2

Treatment and prevention of seroma

Back 2

Tx: Aspiration, drainage, packing, or observation
Prevention: ?, Proper tissue handling

Front 3

treatment and prevention of hematoma (High risk for infection)

Back 3

Tx: Aspiration, drainage, packing, or observation
Prevention: Hemostasis, Proper tissue handling

Front 4

Treatment and prevention of infection

Back 4

Tx: Open drainage, packing, culture, antibiotics
Prevention: Sterile technique, ?antibiotic prophylaxis, irrigation

Front 5

Separation of fascial layers in the early postoperative period. Pink “lemonade” colored fluid

Back 5

Dehiscence

Front 6

Treatment and prevention of dehiscence

Back 6

Tx: Return to OR, Closure. ?Retention sutures, fascial debridement. If it is small, it can be packed and observed
Prevention: Good closure technique >1cm thick, consider interrupted instead of continuous running suture, nutrition check, proper tissue handling

Front 7

Protrusion of intestines outside of fascial layer, and possibly outside skin, from dehiscence

Back 7

Evisceration

Front 8

Treatment and prevention of Evisceration

Back 8

Tx: Emergency. Wrap intestines in saline moistened towel. Return to OR, Closure. ?Retention sutures. Absorbable mesh if unable to close, then delayed elective return for repair of hernia several weeks later.
Prevention: Same as dehiscence.

Front 9

Causes of hypothermia

Back 9

Traumatized patients
Late septic shock
Rapid transfusion of cool fluids
Prolonged exposure/surgery

Front 10

What's the problem?

Rare, autosomal dominant disorder of skeletal ms.
Triggered by exposure to certain anesthetic inhalants such as halothane and enflurane, but also newer agents as well
Succinylcholine

Back 10

Malignant Hyperthermia

Front 11

symptoms of MH

Back 11

High fever, tachycardia, muscle rigidity, cyanosis

Front 12

Tx of MH

Back 12

Dantrolene 2.5mg/kg IV, Oxygenate, Cool patient, treat acidosis and electrolyte imbalances

Front 13

Post Operative Fever (Most common order of 5 W’s)

Back 13

Wind: Atelectasis
Wound: Infection or Hematoma
Water: Urinary Tract Infection
Waste: Lower GI Tract diarrhea and/or colitis
Wonder Drug: Drug Reactions

Front 14

treatment and prevention of post-op fever

Back 14

Treatment equals prevention and proper diagnosis
Antibiotic administration is not the first treatment of choice
Antipyretics are used if patient is uncomfortable
Be alert for sources of infection

Front 15

A collapse of alveoli
Dx: Fever, crackles, CXR localized haziness

Back 15

Atelectasis

Front 16

Tx for atelectasis

Back 16

Aggressive Pulmonary Toilet such as Incentive Spirometry, deep breathing and cough, aerosol breathing treatments, ambulation

Front 17

Infection/Inflammation
Dx: Fever, crackles, egophony, CXR localized consolidation, witnessed aspiration of secretions

Back 17

Pneumonia

Front 18

Tx of pneumonia

Back 18

Aggressive Pulmonary Toilet, Antibiotics, and prevention of aspiration

Front 19

Fluid overload due to aggressive fluid rescuscitiation
Fluid overload due to congestive heart failure
Dx: Exam, crackles/congestion, CXR blunting

Back 19

Pulmonary edema

Front 20

Tx of pulmonary edema

Back 20

Tx: Prevention, diuresis, Afterload reducing agents

Front 21

Inflammation of alveoli, capillary thickening
Dx: Hypoxia, CXR Patchy infiltrates

Back 21

Adult Respiratory Distress Syndrome (ARDS)

Front 22

Tx of ARDS

Back 22

Tx: Respiratory support, keep PaC02 near 40 mmHg, many require sedation and controlled mechanical ventilation

Front 23

Devastating complication
A common cause of sudden post-op arrest resulting in death
Occurs by propagation of deep vein thrombus (DVT) to the pulmonary arteries causing occlusion, resulting in massive loss of oxygenation
Thrombus usually occurs in the ileofemoral veins (deep veins)

Back 23

Pulmonary Embolus

Front 24

Presentation of Pulmonary embolus

Back 24

Acute chest pain, hypoxia, arrest, cyanosis, tachypnea, tachycardia, hemoptysis (rare)

Front 25

Dx of PE

Back 25

Dx: Arterial Blood Gas, CXR (Westermark’s sign), EKG (S1 Q3 T3, RBBB, RAD), Chest CT Angiogram

Front 26

Diagnosis and treatment of acute MI is unchanged, except for______ therapy in post op period
(Aspirin, Beta Blockers, and anticoagulation)

Back 26

thrombolytic

Front 27

Inability to evacuate urinary bladder in post-op period 6-8 hours

Back 27

Urinary Retention

Front 28

Adrenal Insufficiency
Most commonly due to abrupt cessation or discontinuation of WHAT

Back 28

glucocorticoids that were given prior to surgery

Front 29

Symptoms of Adrenal Insufficiency

Back 29

Cardiovascular shock, fever, mental confusion, abdominal pain
Hyponatremia, hyperkalemia, hypoglycemia, azotemia

Front 30

Tx of Hyperthyroidism and Thyroid Storm

Back 30

Recognition, Beta-blockers, Lugol’s Iodine solution, Propylthiouracil

Front 31

Unexplained hyponatremia, nausea, vomiting, seizures

Back 31

SIADH

Front 32

Tx for SIADH

Back 32

Fluids and IV Normal Saline, rarely use 3%NS

Front 33

Tx for paralytic ileus

Back 33

Patience, ambulation, correct electrolytes, gastric decompression, parenteral nutrition, metoclopramide, bisacodyl, gum chewing

Front 34

Tx for bowel obstruction

Back 34

Gastric decompression, parenteral nutrition, surgery if unresolved, closed loop bowel obstruction is a surgical emergency due to vascular compromise

Front 35

x-ray of paralytic ileus

Back 35

Non-specific Gas Pattern

Front 36

x-ray of bowel obstruction

Back 36

Stacking of bowel, stair stepping of gas pattern

Front 37

Tx for Bile Duct Injuries

Back 37

CT Guided drainage of Biloma
ERCP with Stent
Biliary surgical drainage via choledochal-duodenostomy, choledochal-jejunostomy or Roux-en-Y