Post-Operative Complications
·
Usually takes 3 – 5 days
·
Wound infection:
o Redness, induration
o Either:
· Abscess: red, hard mass ® needs drainage
·
Cellulitis: red, hot, painful ®
antibiotics
·
Abdominal infection:
o Often 5 – 7 days before apparent: pain, ileus, sweats, rigours
o Investigations (to look for abscess): Maybe US. CT better
o Treatment:
· Small abscess: if deep and < 3 cm try antibiotics
·
Large abscess: if > 4 cm then
drain either surgically or under radiological guidance. Depends on depth, if
its loculated or presence of overlying bowel
·
Peripheral line
· Central line: may look innocent – but consider if no other locus found. Can leave a central line in for 4 – 6 weeks if you look after it
· Chest infection:
o Usually results from atelectasis following poor ventilation (especially immediately following extubation, especially if pain)
o Look for ¯saturation and fever (especially if it occurs the night following
surgery) – this is initially due to inflammation – so it presents quicker than
the above infections
o Management:
§ Effective analgesia
§ Chest physio: deep breaths and cough each hour
·
Overall management:
o Check wound, chest, iv sites, abdomen, UTI. Check for signs of meningism, endocarditis,
DVT
o Do FBC, culture. Consider MSU,
CXR, abdo US
·
Lie flat and give O2
·
Check pulse and other vitals
·
Consider:
o Hypovolaemia: check fluid chart, replace losses
o Haemorrhage: review wounds
o Cardiogenic: any heart history?
o Sepsis
o Anaphylaxis
·
Causes: Mechanical obstruction,
paralytic ileus, emetic drugs (opiates, digoxin, anaesthetics), systemic or GI
illness
·
Consider AXR, NGT, antiemetic
(metoclopramide or cyclizine)
·
If it‟s a long operation, a clot
may start to form then and propagate ® inflammation ® mild
fever
·
If immobile or in pain, then may
form post-operatively
·
High probability of a DVT if:
o Calf circumference > 3 cm than the other
o Malignancy
o Immobile
o Local tenderness
o Family history
·
Test using Doppler US (for flow)
· See also Topic: Deep Vein Thrombosis (DVT)
· Ie Delirium.
·
Causes (especially if already
borderline):
o Infection
o Hypoxia
o Metabolic: glucose, K
o CVA or MI
o Drugs:
§ Too little: eg withdrawal of sleeping pills, insufficient analgesia
§ Too much: eg morphine ® ¯respiration, pinpoint pupils. Treat with naloxone (but short T½ so may need to repeat)
o Delirium tremens (alcohol withdrawal)
o Urinary retention
o No cause found
·
Management: Quiet, gently lit
area, familiar faces. Consider midazolam
or haloperidol
·
= < 30 ml/hour
· Causes:
o Hypovolaemia: HR, ¯BP, peripherally shut down
o Urinary retention: ?palpable bladder
o Catheter blockage (especially if sudden drop off)
o Renal failure due to hypotension, nephrotoxic drugs, transfusion
·
Management: If not overloaded
then treat with fluids: normal saline unless significant blood loss.
·
Don‟t use dextrose – won‟t stay
in the blood for long
·
= Wound breakdown (eg of a gut
anastamosis). Usually after 5 – 7 days due to ischaemic tension, infection, etc
·
Symptoms: severe pain, ¯bowel
sounds
·
Investigation: CT with
gastrographin contrast
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