Page 1 of 1: p/o compli

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Theme : Post operative complications

A. Chest infection
B. Myocardial infarction
C. Pneumothorax
D. Post op anaemia
E. Pulmonary embolism
F. Systemic inflammatory response syndrome (SIRS)

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Select the most likely diagnosis in the following cases who have undergone surgery.

1) 72 hours post left hemi – colectomy a 69 year old male smoker complains of chest pain associated with shortness of breath. On examination he has full air entry in his chest. His observations reveal a pulse of 110 bpm, regular, a Blood Pressure of 100/75 mmHg, respiratory rate of 32 and a temperature of 36.5oC. Full blood count, U&E and troponin have been sent. His gases on air are: pO2 8.1 kPa, pCO2 3.2 kPa and pH 7.5.

2) 5 days post abdominal aortic aneurysm repair a 72 year old man complains of shortness of breath. On examination he has decreased breath sounds at both bases. He has a white count of 13.6x106/l, a temperature of 38.2oC, a pO2 10.1 kPa and pCO2 4.5 kPa and pH of 7.4.

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Pulmonary embolism. The differential for this man would include myocardial infarction and infection; with the information currently available you have to treat as a PE because he is hypoxic despite his tachypnoea with low pCO2 and is apyrexial. Treatment with supplemental oxygen and heparin should begin whilst waiting for FBC, U&E and troponin to become available. A chest X ray and ECG should be performed and if PE remains the most likely diagnosis a CT pulmonary angiogram/VQ scan should be performed.
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Chest infection. Aortic surgery often leads to diaphragmatic splintage, basal atelectasis and subsequent infection. Aggressive physio, sitting out and early mobilisation are methods of avoiding this but once established treatment should be with antibiotics, physio, humidified oxygen and urgent culture of both blood and sputum to ensure that the organism is treated before it can infect the graft.

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