Post Operative Pyrexia
Atelectasis Fever, reduced oxygen saturation, Get patient sitting out, ensure adequate analgesia to get breathing freely, encourage coughing. Those post abdominal or thoracic surgery vulnerable, smokers, chest physiotherapy to help expectoration. Hydration Wound infections Wounds need inspection for inflammation and infection. May be due to poor wound closure. Swab if there is frank pus. Start antibiotics Hospital acquired Pneumonia Cough, sputum, fever, consolidation on CXR DVT and PE Swelling of leg needs duplex. Consider starting treatment dose LMWH if delay and suspicion high Deep abdominal infections Post abdominal surgery. Needs CT UTI/Urosepsis/Catheter related Check urine, send culture, change catheter, Consider antibiotics. Remove catheter if possible.
Inspect the wound, Use pressure to control bleeding. Continuation of bleeding from surgery and a failure to achieve adequate initial haemostasis. It requires aggressive management and may necessitate return. Insert cannula, consider cross match and transfusion.
to theatre. Reactive haemorrhage Inspect the wound, Use pressure to control bleeding. Bleeding from small vessels which begin to bleed as the BP rises postoperatively. Transfusion may be needed. Severe cases may need to return to theatre. Watch Hb. Senior review. Insert cannula, consider cross match and transfusion.
Deep vein thrombosis/Pulmonary embolism High-risk patients should receive prophylaxis. Consider starting treatment dose LMWH if delay and suspicion high
Wound breakdown Anastomotic leaks, fistulas, adhesions,
wound dehiscence, bleeding.
Side effects of anaesthetics and opioids or may be associated with constipation and ileus.
It May be due to hypovolaemia due to dehydration or losses even bleeding, diarrhoea or vasodilation and sepsis or low BP due to spinal anaesthesia. Often oliguria and tachycardia. See haemorrhage above. Watch Hb, U&E. Consider IV fluids.
Vascular events Myocardial Infarction, Stroke, Post op arrhythmias e.g. AF
Delirium post op due to hypoxia, metabolic disturbance, infection,
drugs, or withdrawal syndromes.
Acute Kidney Injury Anuria and oliguria and may be due to preexisting renal disease +/- hypotension, dehydration and most commonly prerenal worsened by nephrotoxic drugs e.g. aminoglycosides, NSAIDs. Once hypovolaemia has been corrected any remaining renal impairment requires specialist renal support.
A low-grade pyrexia is normal in the immediate postoperative
period but may also arise due to infection, collections or DVT
Infections include pneumonia secondary to
pooling of secretions, urinary tract infections and cannula
Surgical site complications include paralytic ileus,
anastomotic leaks, surgical site infections (with secondary
haemorrhage as a result of the infection), fistula
formation and wound dehiscence (total wound
breakdown). Intestinal fistulae may be managed conservatively
with skin protection, replacement of fluid
and electrolytes and parenteral nutrition. If such conservative
therapy fails the fistula may be closed surgically.
Post op pneumonia Due to atelectasis and pre existing lung disease
Postoperative hypoxia is almost always initially due to
perioperative atelectasis unless a respiratory infection
was present preoperatively. Prophylaxis and treatment
involves adequate analgesia, physiotherapy and humidification
of administered gases. Respiratory failure
may occur secondary to airway obstruction. Laryngeal
spasm/oedema may occur in epiglottis or following
traumatic intubation. Tracheal compression
may complicate operations in the head and neck. In
the absence of obstruction hypoxia may result from
drugs causing respiratory depression, infection, pulmonary
embolism or exacerbation of pre-existing
respiratory disease. Respiratory support may be
Prolonged immobility increases the risk of pressure
sores especially in patients with diabetes or vascular
insufficiency. Skincare, hygiene, turning of the patient
and the use of specialised mattresses should prevent
pressure sores. Treatment involves debridement, treatment
of any infection, application of zinc paste and in
severe cases, plastic surgery.
Late postoperative complications which may occur
weeks or years after surgery, include adhesions, strictures
and incisional hernias.
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Post Operative Management
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