Transcript EM Lecture- Acute Surgical Complications

Acute Surgical
Complications
Dr. Simon
Postoperative fever
► Atelectasis
is the most commonly occurs in
the early postoperative period
► The
infections usually become manifest in 4
to 5 days
► 38-38,5º
is the temperatures.
Physical signs and symptoms of
surgical complications
►
Fever
Tachycardia
Oliguria
Jaundice
Abdominal distension
Atelectasis, transfusions
reactions, pulmonary
embolism
Sepsis, hypoxemie,
pain
Hypovolemie, hemolysis
Hemolysis, biliar obstruction,
sepsis
Paralytic ileus, hemorrhage, obstruction
Early postoperative fever
► In
24 hours, after operation, is very
important to made an diognosis of
-streptococcal
-clostridial
Evaluate the clinical situation.
Evaluation
► The
most fever:- pulmonary,
=atelectazi,
=pneumonitis
Essential- auscultation of the lungs,
- not chest film,
-important blood cultures for 38,5º,
-renal infection=nosocomial infection,
-important=test for immunosuppressed, for
cancer.
Mental status abnormalities
► Changes
in mental status; concern in time patient
and family.
► 1 = somnolence, confusion, convulsions, and
coma-affect the brain such as hypoxia,
hypoglicemia, uremia, elevated blood ammonia.
► 2 = Drugs: narcotic, tranquilizers, cimetidine-affect
intracranian lesions.
► 3 = Commonly = septic emboli, and brain
abscesses.
Failure after anesthesia
► 1.
Cerebrovascular accident-if they have
preoperative carotid occluded ½.
► 2. More commonnly, agitation and anxiety
immediate postoperative period, and pain –
fortunately is such discomfort (naloxone)
► 3. Agitation and anxiety induce by hypoxemia, or
intraabdominal hemorrhage-appropriate
intervention.
► 4. Hallucinations after meperidine,= change this.
Delirium tremens
► Alcoholic
patients = sindrom of agitation
and tremors, hallucinations and convulsions.
= hyperpyrexia,
dehydration, insufficiency adrenal – required
medical hydration, sedation (thorazine),
rarely intravenous alcohol, vit. B1, b6, b12,
and for convulsions barbiturates.
A.Infections
► Major
postoperative intraabdominal and
intratoracic infections increase patient
morbidity, cost and mortality.
► An abscesses generalized peritonitis or
mediatinitis = multiple organ failure.
► Diagnosis needs to be accurate, for an
recovery with surgery
General considerations
► Fever
and pain particulary,
► Leukocyte 1. low rate and grade is common
if the fever is 38º and decrease,
2. loukocytosis occurring later
with fever and (left shift), is indicate an
infection
Features of the operation
► -patient
with simple extirpation now risk,
► -patient
with bowel anastomosis are at
greater risk for intraperitoneal abscess.
► CT,
radiology, ultrasonografhy for accure
localization.
A.1. Intra-abdominal infection
► A.
Intraperitoneal abcesses occur most
commonly- fever, pain,
=after appendicectomy and
colon resections,
=pelvic absces, after sigmoid
perforation of diverticulum
Treatment
► After
simply digital or vaginal examination =
with ultrasonografy or CT drained through
the rectum or vagina, or op.
► Alternatively
= a small lower abdominal
incision may be necessary to completely
evacuated.
B.2.Subphrenic and subhepatic
abscesses
► Is
commonly following operations on upper
abdominal organs.
=X-ray, CT, an elevated
hemidiafragm, and bubbles or air
=scintigrafy of splen
Tr. Surgycal in 2-4 days.