Surgical Complications

Atelectasis

Alveolar collapse, due to proximal mucous plugs Causes a VQ mismatch May have tachypnoea, tachycardia & pyrexia ABG   PaO2 = respiratory failure PaCO2 = Type I respiratory failure pH = Alkalosis (respiratory) N HCO3 = Acute (no metabolic compensation) Treated by physiotherapy, but may be aided by nebulised bronchodialators, such as salbutamol

Infection

Pneumonia   Commonest is bronchopneumonia Due to Haemophilus Influenzae or Streptococcus Pyogenes Characterised by tachypnoea, tachycardia, pyrexia, cyanosis and purulent sputum ABG   PaO2 = respiratory failure PaCO2 = Type I respiratory failure pH = Alkalosis (respiratory) N HCO3 = Acute (no metabolic compensation) Culture sputum Antibiotics - amoxycillin Physiotherapy and deep breathing exercises Urinary Tract Infection (UTI)   Risk factors - Women and catheterisation Clinical features   Pyrexia Irritative symptoms   Dysuria Frequency Nocturia Urgency Incomplete voidance Treatment - Adequate fluids + antibiotics (Trimethoprim) Cellulitis   Occurs at wound site Characterised by erythema, tenderness and discharge Due to staphylococci or streptococci Swab wound discharge & blood culture Usually settles without treatment, but may require antibiotics May lead to an abscess, requiring surgical drainage Phlebitis   Occurs at IV, or central line site Characterised by erythema, tenderness and discharge Due to staphylococci or streptococci Swab discharge & blood culture Usually settles without treatment, but may require antibiotics Sepsis   Causes   UTI Pneumonia Cellulitis Abscess Phlebitis Clinical features (Hyperdynamic circulation)   Tachycardia Tachypnoea Hypotension (Septic shock) Pyrexia Commonest organisms   Gram -ve bacteria Management   Culture blood, sputum, urine & wound discharge Coagulation studies, ABG IV antibiotics Find focus of infection Monitor closely in ICU Fluid management Maintain oxygenation

Haemorrhage

Acute   Due to inadequate haemostasis Should be considered as primary haemorrhage, and if substantial, surgically re-explored Check aspirin, heparin & warfarin use Consider coagulation profile Reactionary   Postoperative BP restoration If substantial, surgically re-explored Late   Caused by infection Treated with antibiotics May require surgical exploration

Pulmonary Embolus (PE)

Caused by a DVT Usually asymptomatic or may present with confusion or pyrexia Characterised by sudden dyspnoea, pleuritic chest pain and haemoptysis ABG   PaO2 = respiratory failure PaCO2 = Type I respiratory failure pH = Alkalosis (respiratory) N HCO3 = Acute (no metabolic compensation) Pleural rub, ECG - Enlarged S wave in V1, Q wave in V3, and inverted T wave in V3 (S1 Q3 T3) Diagnosed by VQ scan Treatment same as for DVT

Impaired wound healing

Arterial insufficiency Excess sututre tension Drugs   Immunosuppressants Steroids Radiotherapy Malnutrition Vitamin deficiency

Renal

Urinary retension   Causes   Inadequate post operative analgesia Gross constipation Treatment   Conservative - Quiet, private environment, standing up is helpful If conservative treatment fails - Urinary Catheter Acute Renal Failure (ARF)   Acute oliguria / anuria in the postoperative period Causes   Prerenal (Hypovolaemia) Renal (Incompatible transfusion, Sepsis, Drugs (Aminoglycoside antibiotics)) Post renal (Catheter obstruction) Treatment   Urinary catheter - To measure urine output Fluid restriction until renal function recovers If no recovery, or complete anuria, patient may require dialysis or haemofiltration