p.8
Neurologic Complications Post-Surgery
What should the surgical team evaluate in patients presenting with delirium?
Underlying causes before proceeding with pharmacologic treatment.
p.2
Wound Complications and Healing
What can lead to incisional hernias?
Incomplete healing of the fascia, resulting in weakness of the surgical wound.
p.5
Respiratory Distress in Postoperative Patients
What is Acute Respiratory Distress Syndrome (ARDS)?
Essentially non-cardiogenic pulmonary edema mediated by widespread inflammation in the lungs.
p.6
Acute Kidney Injury and Oliguria
What mediates prerenal AKI?
ADH and the renin-angiotensin axis, leading to decreased GFR and urine output.
p.4
Respiratory Distress in Postoperative Patients
What are some differential diagnoses for postoperative respiratory distress?
Atelectasis, pneumonia, aspiration, pulmonary edema, ARDS, pulmonary embolism, fat embolism, and narcotic overdose.
p.1
Postoperative Complications Overview
What is the primary goal of postoperative assessment?
To ensure proper healing and rule out the presence of complications.
p.10
Postoperative Complications Overview
What are common signs of deep infections after surgery?
Pain, fevers, or ileus, especially after GI surgery.
p.2
Wound Complications and Healing
What defines a clean-contaminated wound?
GI, GU, or respiratory tract entered without spillage, non-traumatic wound, no inflammation.
p.8
Neurologic Complications Post-Surgery
What are some risk factors for developing delirium?
Advanced age, dementia, prior episodes of delirium, polypharmacy, and sensory impairment.
p.8
Stress Ulcers in Surgical Patients
What factors promote the formation of the gastric mucous layer?
Prostaglandins, nitric oxide, and vagal nerve stimulation.
p.9
Respiratory Distress in Postoperative Patients
What are common causes of hypoxia and hypercapnia in postoperative patients?
Drugs of abuse, withdrawal from alcohol and benzodiazepines, and medications like opioids, benzodiazepines, sedatives, antihistamines, and antimuscarinics.
p.2
Wound Complications and Healing
What are the four classifications of surgical wound contamination?
Clean, Clean-contaminated, Contaminated, Dirty.
p.8
Neurologic Complications Post-Surgery
What is the prevalence of postoperative delirium in older surgical patients?
10-50%, with higher rates in the ICU setting.
p.8
Stress Ulcers in Surgical Patients
What happens to the mucous layer during severe illness or physiologic stress?
It becomes less effective due to decreased bicarbonate concentrations.
p.2
Wound Complications and Healing
What is dehiscence?
The disruption of a wound that was primarily closed, leading to loss of barrier and structural functions.
p.2
Wound Complications and Healing
When does complete wound healing typically occur?
In the first 6-8 weeks after surgery.
p.9
Wound Complications and Healing
What is the typical presentation of superficial infections?
Cellulitis or superficial abscess.
p.5
Respiratory Distress in Postoperative Patients
What are the most common etiologies of ARDS?
Sepsis, pneumonia, aspiration, severe trauma, and massive transfusions.
p.3
Wound Complications and Healing
How do incisional hernias differ from dehiscence?
Hernias have contents contained within a sack of peritoneum, preventing bowel exposure to the atmosphere.
p.5
Respiratory Distress in Postoperative Patients
What occurs during a pulmonary embolism (PE)?
Thrombus within the pulmonary arterial system causing hemodynamic and respiratory consequences.
p.1
Wound Complications and Healing
What factors can impair wound healing?
Bacterial infection, necrotic tissue, foreign bodies, diabetes, smoking, malignancy, malnutrition, poor blood supply, global hypotension, hypothermia, immunosuppression, emergency surgery, ascites, severe cardiopulmonary disease, and intraoperative contamination.
p.3
Postoperative Fever and Its Causes
What is the 5 Ws mnemonic used for?
To remember the common causes of fever after surgery.
p.10
Postoperative Complications Overview
What is a key sign of an intra-abdominal anastomotic leak?
Tachycardia, particularly in obese patients.
p.1
Wound Complications and Healing
When do abscesses secondary to anastomotic leak typically present?
Around postoperative day 5-7.
p.10
Wound Complications and Healing
What does wound dehiscence present with?
Spontaneous opening of the wound edges, possibly with leakage of fluid or stool.
p.1
Postoperative Complications Overview
What is the significance of fluids and electrolyte shifts after surgery?
They are normal and their management is important for healing and progression.
p.11
Postoperative Fever and Its Causes
What are the signs of a wound infection?
Incisional erythema, purulent drainage, deep abscess, and pain.
p.8
Stress Ulcers in Surgical Patients
What protects the gastric mucosa?
A mucous layer that creates a barrier and buffers acid with bicarbonate.
p.9
Neurologic Complications Post-Surgery
What factors increase the risk of postoperative stroke?
Advanced age, comorbidities (like diabetes and hypertension), smoking, history of CVA or TIA, carotid stenosis, intraoperative factors, hypovolemia, and postoperative heart failure.
p.4
Postoperative Complications Overview
What are common organisms involved in postoperative infections after colon surgery?
C. perfringens and beta-hemolytic Streptococcus.
p.9
Neurologic Complications Post-Surgery
What are the two types of strokes mentioned in the text?
Ischemic and hemorrhagic strokes.
p.1
Postoperative Complications Overview
What systems can be affected by postoperative complications?
Neurologic, cardiovascular, pulmonary, renal, gastrointestinal, hematologic, endocrine, and infectious systems.
p.7
Ileus and Its Management
What is ileus?
Intestinal paralysis common in hospitalized patients, especially surgical and trauma patients.
p.6
Acute Kidney Injury and Oliguria
What is a common cause of postrenal AKI?
Obstruction of the urinary tract, such as BPH or kidney stones.
p.5
Acute Kidney Injury and Oliguria
What is oliguria?
Low urine output, often the first sign of acute kidney injury (AKI).
p.1
Wound Complications and Healing
What is a critical factor when reapproximating tissue during surgery?
Tension on the wound edges.
p.10
Wound Complications and Healing
What is an incisional hernia and how does it present?
Bulging and pain at the incision site, which can occur acutely or gradually.
p.9
Neurologic Complications Post-Surgery
What type of strokes are most common after general surgery?
Ischemic and embolic strokes.
p.9
Neurologic Complications Post-Surgery
What is a potential complication of carotid endarterectomy that can lead to a stroke?
An intimal flap within the lumen of the carotid artery that occludes flow.
p.9
Neurologic Complications Post-Surgery
What can contribute to surgery-induced hypercoagulability?
General anesthesia, bed rest, and withholding of antiplatelet and anticoagulant therapy.
p.7
Hypotension in Postoperative Care
Why do patients with adrenal insufficiency require additional glucocorticoids during stress?
To maintain systemic vascular resistance (SVR) and blood pressure.
p.6
Acute Kidney Injury and Oliguria
What are some causes of acute tubular necrosis (ATN)?
Prolonged hypoperfusion, nephrotoxic substances, and drugs such as myoglobin and certain antibiotics.
p.7
Ileus and Its Management
What are common risk factors for developing ileus?
Abdominal surgery, electrolyte imbalances, narcotic pain medication, immobility, sepsis.
p.5
Acute Kidney Injury and Oliguria
What are the types of causes for AKI?
Prerenal, intrinsic renal, and postrenal obstructive causes.
p.5
Acute Kidney Injury and Oliguria
What is contrast-induced nephropathy often characterized as?
Non-oliguric, where the patient has normal urine output but decreased clearance ability.
p.11
Postoperative Fever and Its Causes
What are the signs of pneumonia postoperatively?
Respiratory distress, hypoxemia, cough, purulent sputum, and infiltrates on chest x-ray.
p.10
Postoperative Fever and Its Causes
What can postoperative fever indicate?
It can be a normal inflammatory response or a sign of infection.
p.2
Wound Complications and Healing
What are some risk factors for wound dehiscence?
Poor nutritional status, diabetes, obesity, smoking, immunosuppression, advanced age, infection, and poor surgical technique.
p.9
Wound Complications and Healing
What are the signs of superficial wound infections?
Erythema, induration, pain, and purulent drainage.
p.4
Postoperative Fever and Its Causes
What is a common cause of drug fever in postoperative patients?
Antibiotics and sulfa drugs.
p.3
Wound Complications and Healing
What conditions can contribute to the development of an incisional hernia?
Chronic cough (COPD), ascites, or pregnancy.
p.7
Hypotension in Postoperative Care
What is a common arrhythmia that can occur postoperatively?
Atrial fibrillation with rapid ventricular response (RVR).
p.10
Postoperative Complications Overview
What does new onset ileus after GI surgery indicate?
It may indicate peritoneal inflammation, possibly due to an intra-abdominal abscess.
p.6
Hypotension in Postoperative Care
What serious conditions can cause hypotension in postoperative patients?
Bleeding, sepsis, adrenal insufficiency, or cardiac causes.
p.6
Hypotension in Postoperative Care
Why is it important to rule out bleeding as a cause of hypotension postoperatively?
It may require a return to the operating room if not addressed.
p.6
Hypotension in Postoperative Care
What can cause distributive shock in sepsis?
A massive inflammatory response to infection leading to vasodilation and increased capillary permeability.
p.11
Postoperative Fever and Its Causes
What is SIRS and how is it defined?
Systemic Inflammatory Response Syndrome (SIRS) is defined by exhibiting two of the four criteria: hyper/hypothermia, tachycardia, tachypnea, and abnormal WBC count.
p.11
Postoperative Fever and Its Causes
What is sepsis?
Sepsis is defined as meeting SIRS criteria with a known source of infection.
p.3
Postoperative Fever and Its Causes
What is the most common nosocomial infection in the hospital overall?
Urinary tract infection (UTI).
p.10
Postoperative Fever and Its Causes
What defines postoperative fever?
A temperature above 38.0 Celsius (100.4 F).
p.8
Neurologic Complications Post-Surgery
What are some common precipitating factors that can cause delirium?
CNS disorders, infections, and metabolic disturbances.
p.7
Hypotension in Postoperative Care
What can adrenal insufficiency lead to postoperatively?
Systemic hypotension due to low levels of glucocorticoids.
p.6
Acute Kidney Injury and Oliguria
What causes prerenal acute kidney injury (AKI)?
Transient renal hypoperfusion due to hypovolemia, hypotension during surgery, or decreased cardiac output.
p.7
Hypotension in Postoperative Care
What can cause refractory hypotension in patients on steroids?
Iatrogenic suppression of the HPA axis leading to adrenal insufficiency.
p.7
Hypotension in Postoperative Care
What cardiac issues can lead to postoperative hypotension?
Acute myocardial infarction, exacerbation of congestive heart failure, or arrhythmias.
p.4
Respiratory Distress in Postoperative Patients
What can aspiration during surgery lead to?
Chemical pneumonitis and potentially bacterial infection.
p.4
Respiratory Distress in Postoperative Patients
Why does aspiration usually affect the right middle and lower lobes?
Due to the larger caliber and straighter course of the right mainstem bronchus.
p.5
Acute Kidney Injury and Oliguria
What are the three main categories of risk factors in Virchow’s Triad?
Stasis of blood flow, endothelial injury, and hypercoagulability.
p.1
Wound Complications and Healing
What can cause surgical site infections (SSI)?
Bacterial contamination in the surgical field.
p.4
Respiratory Distress in Postoperative Patients
How does heart failure contribute to pulmonary edema?
Decreased left ventricular cardiac output causes fluid to back up in the pulmonary veins, increasing hydrostatic pressure.
p.11
Postoperative Fever and Its Causes
What are the white blood cell count thresholds for leukocytosis and leukopenia?
WBC > 12 cell/mm³ for leukocytosis and < 4 cell/mm³ for leukopenia.
p.6
Hypotension in Postoperative Care
What are common causes of hypotension after surgery aside from serious conditions?
Hypovolemia due to insensible losses or reactions to drugs like narcotics and sedatives.
p.10
Wound Complications and Healing
What are the signs of abdominal fascial dehiscence?
Erythema of the skin, leakage of salmon-colored fluid, or leakage of succus or stool.
p.10
Wound Complications and Healing
What are the symptoms of bowel incarceration in an incisional hernia?
Worsening pain, obstructive symptoms like nausea and vomiting, and lack of bowel movements.
p.11
Postoperative Fever and Its Causes
What is the 'Wonder Drug' diagnosis?
A diagnosis of exclusion after other causes of fever are ruled out.
p.7
Hypotension in Postoperative Care
What are the two types of adrenal insufficiency?
Primary (Addison’s disease) and secondary due to suppression of the HPA axis.
p.5
Respiratory Distress in Postoperative Patients
What mediates the increased permeability of alveolar capillary membranes in ARDS?
Inflammatory cytokines such as IL-1, IL-6, and TNF.
p.6
Acute Kidney Injury and Oliguria
What is the most common type of intrinsic renal injury?
Acute tubular necrosis (ATN).
p.3
Wound Complications and Healing
What increases the risk of developing an incisional hernia?
Surgical site infections.
p.4
Respiratory Distress in Postoperative Patients
Which patients are at high risk for aspiration during induction of anesthesia?
Patients who have not fasted, trauma patients, pregnant patients, and those with certain GI tract pathologies.
p.10
Wound Complications and Healing
What is necrotizing fasciitis and how does it present?
A rapidly progressing soft tissue infection that may present with pain beyond external signs, crepitus, and dish-water fluid.
p.4
Respiratory Distress in Postoperative Patients
What causes pulmonary edema in postoperative patients?
Abnormal movement of fluid across the alveolar capillary membrane due to an imbalance of Starling forces.
p.11
Postoperative Fever and Its Causes
What respiratory rate indicates tachypnea?
RR > 20 breaths/min or PaCO2 < 32 mmHg.
p.7
Stress Ulcers in Surgical Patients
Who is at risk for developing stress ulcers?
Patients with massive burn injury, severe head injury, trauma, sepsis, and multisystem organ failure.
p.3
Postoperative Fever and Its Causes
What are common risk factors for atelectasis and pneumonia post-surgery?
Incisional pain, shallow breathing, depressed cough from narcotics, pulmonary edema, prolonged bedrest, and smoking history.
p.3
Postoperative Fever and Its Causes
What can cause venous thromboembolic disease (DVT, PE) postoperatively?
An inflammatory reaction resulting in fever.
p.11
Postoperative Fever and Its Causes
What are the signs of a pulmonary embolism (PE)?
Respiratory distress, cough, chest pain, tachycardia, tachypnea, and hypoxemia.
p.6
Acute Kidney Injury and Oliguria
What can cause acute interstitial nephritis (AIN)?
Infection or allergic reactions to drugs like antibiotics and NSAIDs.
p.5
Acute Kidney Injury and Oliguria
What is Virchow’s Triad used for?
Categorizing risk factors for venous thromboembolic disease (VTE).
p.1
Wound Complications and Healing
What are common wound complications?
Infection, dehiscence, and incisional hernia.
p.5
Acute Kidney Injury and Oliguria
Who is at higher risk for oliguria and AKI?
Patients with preexisting chronic kidney disease (CKD).
p.1
Wound Complications and Healing
What types of bacteria are typically responsible for aggressive necrotizing infections?
Clostridium perfringens or beta-hemolytic Group A Streptococcus.
p.11
Postoperative Fever and Its Causes
What are common signs of a urinary tract infection (UTI) postoperatively?
Dysuria, hematuria, cloudy urine, and delirium, especially in elderly patients.
