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postoperative complications, emergency Management for Patients with…
postoperative complications
Respiratory complications
Postoperative hypoxia
shortness of breath
agitation
upper airway obstruction
cyanosis
Cardiovascular complications
Hypotension in the postoperative period can be multifactorial • _ Arrhythmias can be prevented and corrected by treating hypotension and electrolyte imbalance
• _ Arrhythmias and myocardial ischaemia/infarction will need
management with the help of cardiologists
renal and urinary complications
Postoperative renal failure is associated with high mortality. • _ Prophylactic measures to prevent renal failure should be taken in high risk cases.
• _ Urinary retention and infection are a common problem
postoperatively.
Common causes of acute renal failure
Renal
Nephrotoxic drugs
nonsteroidal antiinflammatory agents)
gentamicin, diuretics,
surgery involving renal vessels
Myoglobinuria
Sepsis
Postrenal
Ureteric injury
Blocked urethral catheter
Prerenal
Hypotension
Hypovolaemia
complications after abdominal surgery
Bleeding or abscess
Anastomotic leakage
Paralytic ileus
Compartment syndrome
greater than expected pain unresponsive to analgesia
Paralysis, paraesthesia and pulselessness are very late signs
Pain treatment
Third step. Strong opioids
morphine or pethidine.
First step. Simple analgesics
aspirin, paracetamol, nonsteroidal anti-inflammatory agents, tricyclic drugs or anticonvulsant drugs.
Second step. Intermediate strength opioids
codeine, tramadol or dextropropoxyphene
Postoperative bleeding
major
Need to transfuse blood
absence of continued bleeding
Hb >8 g/dL
minor
airway can have a catastrophic effect
Postoperative Fever
small percentage turn out to be due to infection
depending on type of surgery but only
first 24 hours after a major surgery
natural and non-infectious inflammatory response to tissue injury sustained
in the procedure itself
often requires no medical intervention
Thrombosis
risk factors for thrombosis.
Reduced mobility for more than 3 days
Pregnancy/puerperium
Trauma or surgery (especially of the abdomen, pelvis and lower limbs), anaesthesia >90 minutes
varicose veins with phlebitis
Obesity: body mass index (BMI) >30 kg/m2
Drugs, e.g. oestrogen contraceptive, hormone replacement therapy (HRT), smoking
Age >60 years
Known active cancer or on treatment, significant medical comorbidities, critical care adm
Family/personal history of thrombosis, e.g. deficiencies in • antithrombin III, protein S and C
emergency Management for Patients with Hypoxia
Recognition of Hypoxia:
Identify patients with hypoxia or imminent signs
Oxygen Administration:
If breathing spontaneously, administer oxygen at 15 L/min
Use a non-rebreathing mask for effective oxygen delivery
Airway Management:
Perform a head tilt, chin lift, or jaw thrust to relieve obstruction due to reduced muscle tone.
Suction blood or secretions if necessary.
Insert an oropharyngeal airway if needed.
Calling for Assistance:
Call the anaesthetist for potential tracheal intubation and manual ventilation
polmonary embolism:
In the presence of a large embolism
pulmonary hypertension
elevated central venous pressure (CVP)
systemic hypotension
sudden onset of chest pain
shortness of breath
Management of Neck Wound Hematoma:
Immediate Evacuation:
Neck wound hematoma is a life-threatening emergency.
Evacuate immediately under local or general anesthesia.
Additional Interventions:
Administer appropriate antibiotics.
Perform chest physiotherapy.
Use bronchodilators for pneumonia treatment.
Pulmonary Edema Management:
Initiate diuretics.
Seek cardiology opinion for further evaluation.
Laryngeal oedema
traumatic tracheal intubation,
recurrent laryngeal nerve palsy
tracheal collapse after thyroid surgery.
• Atelectasis and pneumonia
especially after upper abdominal and thoracic surgery
pulmonary oedema
cardiac origin or related to fluid overload.
suprasternal recession)
residual effect of general anaesthesia