Med contexts

all subjects

Risk factors for N/V post operatively?

• being female

• previous hx of it

• opioids

• lap surgeirs

• prolonged op time

• poor pain control post surgery

complications: impacts 1/3 of ppl, = inc length of stay, anxiety, aspiration pneumonai , metabolic alkalosis and complications

*figure out if N is from surgery or from complication or from infection!

Early complications of surgeries?

• Bleeding / haemorrhage → tachycardia, hypotension, falling Hb

• Infection → wound infection, sepsis

• DVT / PE → leg swelling/pain or sudden dyspnoea/chest pain

• Respiratory complications → atelectasis, pneumonia, aspiration

• Cardiovascular complications → MI, arrhythmia

• Urinary retention / AKI

• Post-operative delirium, especially in older patients

• Nausea and vomiting

• Pain

Later complications of surgery?

• Wound separation

• Anastomotic leak → particularly important after bowel surgery

• Wound/organ-space infection or abscess

• Incisional hernia

• Adhesions → bowel obstruction eg) ileus (bowels stop moving)

• Chronic pain

• Poor wound healing

what to do in pre-op admission 2w prior?

-comobidities mx

-surgical + anaesthetic hx

-general ex + airway ex for intubation

-ASA grade risk of post op complications and absolute mortality

-NICE guides on IX:

-FBC ( anaemia or thrombocytopaenia)

-UEC (renal fx & fluids/ drugs to preserve kidney fx)

-LFT (metabolism & fx)

-± HbA1c, TFT, coag profile

group save & hold & screen ±cross match

Causes of Pyrexia (fever/ raised temp/ delirium) post surgery based on days post-op?

Wind — > Water —> Walk —> Wound —> Wonder drugs

*basically review interventions we did: meds + bloods + cannulas + implants

Wind: (first two days) “resp”

resp causes: Pneumonia, aspiration, PE or natural

Water (up to day 5) “urine”

UTI/ Sepsis from IV / IDC

Walk (up to day 6) “immobility”

DVT

Wound (days 5-7) Abscess, site of incision, leak from anastomosis

Wonder drugs? (day 7+) check Abs and heparin

Which cases would doing a Venous Blood gas be relevent (it gives us lactate- when cells hypoxic) ?

sepsis & shock, surgery concerns eg: anastomotic leak, bowel ischaemia, or poor tissue perfusion (tells us how much O2 exchanged)

ALSO:

-DKA (assesses met acidosis)

-reduced consciousness (helps to look for metabolic changes)

-Dehydration (impact on metabolic/ lactate)

-Renal failure (acid/base)

Surgical site infections (SSI) cause which type of infections? how to prevent it?

Causes:

• Systemic Inflammatory Response Syndrome (SIRS) multi organ involvemnt ± infection

• sepsis - is multi organ involvemnt with confirmed infection

• abscess - very localised infection full of pus thats necrotising tissue w/ surrounding granulation (Neutrophils)

• Necrotising infections of soft tissue : Cellulitis can progress to nec fac

syx: High or low temp, low O2, high RR, Pulse tachyC, WCC: high

Prevention:

• Patient factors — control: SNAP

  • diabetes, immunosupression, obesity, smoking

• Team factors

  • Doctors maintian sterile field, handling of prosthesis

• Procedural factors

  • Making sure the patient is warm

  • Skin prep with cleaning solution

  • Abx prophyalxis —> used to minimise risk of SSI by ensuring peak amount of Abs during surgery.

• Enironmental factors

  • Sterile field

What are some patient/wound factors that impair wound healing?

• Wound ischaemia (hypoxia)(most common)

  • Inadequate debridement

  • PAD

  • Venous disease

  • Distally based flap

• Too much tension

  • Primary closure of an excessively large defect

  • Inadequate haemostasis

• Pt:

• —> chemo/ radiation/steroids/Nsaids/DMARDs + age + SNAP

ways to reconstruct tissue in order of easiest to hardest?

secondary intention —> primary closure —> delayed —> grafts —> flaps

• In skin graft: Does not carry its own blood supply ∴ depends on the vascularised bed where it is placed

• Two types:

  • Split-skin thickness skin graft (SSG)

    • epidermis + portion of dermis

  • Full-thickness skin graft (FTSG)

    • epidermis + entire dermis

Note:

• Considerations when choosing donor site

  • Amount of skin required

  • Colour, texture

  • Hair growth

• In skin flap: tissue transported carries its blood supply very hard to connect, reduced chance of failure & better cosmetic results.