-
What postop values should you monitoring to prevent/ catch complications? (5)
- fever/ hyperthermia/ hypothermia
- tachy- or bradycardia
- tachypnea or resp distress
- hypertension/ hypotension
- abnormal PCV/TP
-
What are a few common postop problems? (4)
- pain
- blood loss
- hypothermia
- surgical site infection/ sepsis/ aspiration pneumonia
-
What are the adverse effects of hypothermia? (3)
- vasoconstriction
- decrease enzymatic function
- reduced cardiovascular responsiveness
-
What are causes of postop hypothermia? (3)
- excessive heat loss to cold tables, environment
- lack of regulatory mechanisms d/t anesthesia
- open cavities
-
How do you treat hypothermia postop? (2)
- passive warming (hot water blankets, bair huggers)
- active warming (IV or IP fluids)
-
When is active re-warming indicated in a hypothermic patient?
<92-95F
-
What are the adverse effects of fever/ hyperthermia postop? (3)
- increased cellular oxygen demand
- vasodilation and tachycardia
- endothelial damage and necrosis (>105F)
-
Contrast hyperthermia vs pyrexia.
- hyperthermia is increased body temp without resetting of the hypothalamus
- pyrexia is a fever WITH resetting of hypothalamus as a response to inflammatory cytokines
-
What are causes of postop hyperthermia? (3)
- stress/ pain/ increased muscle activity
- upper airway obstruction
- environmental causes (heated cages, water blanket, etc)
-
What re causes of postop fever/ pyrexia? (4)
- infection (not in the immediate postop....infection takes a while to develop)
- inflammation
- neoplasia
- drugs (opioids in cats!)
-
How do you diagnose hyperthermia/ pyrexia? (5)
- search for infection
- search for severe inflammation or neoplasia
- CBC- look for inflammation (pyrexia)
- look for environmental causes (hyperthermia)
- upper airway obstruction (hyperthermia)
-
What is the treatment for hyperthermia? (2)
- passive cooling (cold water bath, fans, alcohol)
- active cooling (IV or IP fluids)
-
How do you treat pyrexia? (1)
anti-pyretics (NSAIDs)
-
What are the adverse effects of tachycardia? (2)
- reduced SV
- increased myocardial workload and oxygen demand
-
_________ is the most common type of tachycardia that occurs postop.
Sinus tachycardia
-
What are causes of tachycardia postop? (6)
- pain and anxiety
- hypoxemia and anemia
- hypovolemia and hypotension
- SIRS/sepsis
- electrolyte disturbances
- ventricular arrhythmias
-
Describe the treatment of tachycardia postop. (5)
- test dose of pain meds (to see if it's d/t pain)
- check BP, ECG, PCV, blood gas
- test dose of fluids (fluid challenge= 10-20mL/kg)
- search for signs of sepsis
- administer anxiolytic
-
What are the adverse effects of bradycardia? (1)
decreased CO and perfusion
-
What are causes of bradycardia postop? (4)
- conduction disturbances
- excessive parasympathetic tone (common in GI dz)
- elevated intracranial pressure
- certain drugs (high dose opioids, alpha-2s)
-
How do you treat postop bradycardia? (2)
- do you even need to treat??? usually no if not symptomatic
- atropine test dose= 0.02mg/kg
-
What are causes of tachypnea postop? (3)
- pain or anxiety
- metabolic acidosis
- pulmonary causes (aspiration pneumonia)
-
How do you work up postop tachypnea? (3)
- auscultation
- pulse ox or blood gas
- thoracic rads or US
-
How is postop tachypnea treated? (2)
- depends on underlying cause
- oxygen supplementation
-
Postop bradypnea is usually...
drug-related (OPIOIDS, bensos, alpha-2s)
-
How do you work up post-op bradypnea, and how is it treated?
- arterial blood gas
- treat by reducing drug dose, +/- mechanical ventilation, oxygen supplementation
-
What are the most common causes of post-op hypertension? (2)
- pain and anxiety
- maybe cushing reflex d/t increased ICP
-
What are common postop causes of hypotension? (4)
- hypovolemia (blood or fluid loss)
- vasodilation (secondary to sepsis)
- reduction of venous return
- cardiovascular dysfunction
-
How do you work up postop hypotension? (3)
- Increased PCV/ TP: hemoconcentration/ loss of free water
- Decreased PCV/ TP: blood loss or hemodilution from fluid therapy
- Increased PCV and decreased TP: splenic contraction, capillary leak secondary to sepsis, GI losses
-
What are possible triggers of SIRS (system inflammatory response syndrome)? (4)
inflammation, infection, trauma, reperfusion injury
-
What are criteria to diagnose SIRS? (4)
- fever
- tachycardia
- hyperventilation or decreased PaCO2
- leukocytosis or leukopenia or left shift
-
What are the physiologic effects of SIRS? (3)
- migration and activation of neutrophils
- cytokine production and ROS (reactive oxygen species--> oxidative damage)
- vasodilation and capillary leak
-
In a hypothermic, hypotensive patient, you should start with ____________ because...
core rewarming (IV or IP fluids); if you start with peripheral rewarming, you're going to cause peripheral vasodilation and decrease BP even further--> start with core rewarming, then add peripheral rewarming once reach 95F
-
|
|