 
Class of 2017
 Go Back | | Session Title: | | SURG: Peri-operative Assessment - Post-operative Complications | | | | Description: | | | | Keywords: |
| Blueprint ID | Learning Objectives | | 1171 | Describe the differential diagnosis of a patient having post- operative fever. For each entity, discuss the clinical manifestations, appropriate diagnostic work-up, and management. (a) intraoperative—malignant hyperthermia (b) within 24 hours—response to surgical trauma, atelectasis, necrotizing wound infections (c) etiology between 24 and 72 hours (d) pulmonary disorders (atelectasis, pneumonia) (e) catheter-related complications (IV-phlebitis, Foley-UTI) (f) etiology after 72 hours (g) infectious causes (pneumonia, wound infection, deep abscess, anastomotic leak, prosthetic infection, acalculous cholecystitis, parotitis) (h) non-infectious causes (deep vein thrombosis) | | 1172 | Explain the following wound complications in terms of predisposing risk factors (patient condition, type of operation, technique) as well as their recognition, treatment, and prevention: (a) hematoma and seroma (b) wound infection (c) dehiscence (d) incisional hernia | | 1173 | Outline the various causes of respiratory distress and respiratory insufficiency that may occur in the post-operative patient. For each complication, describe the etiology, clinical presentation, management, and methods of prevention: (a) atelectasis (b) pneumonia (c) aspiration (d) pulmonary edema (e) ARDS (f) pulmonary embolism (including deep venous thrombosis) (g) fat embolism | | 1174 | Discuss the diagnostic work-up and treatment of oliguria in the post-operative period. Include pre-renal, renal, and post- renal causes (including urinary retention). | | 1175 | Identify the possible causes of hypotension which may occur in the post-operative period. For each etiology, describe its pathophysiology and treatment. (a) hypovolemia (b) sepsis (c) cardiogenic shock, including post-operative myocardial infarction, fluid overload, arrhythmias, and pericardial tamponade (d) medication effects | | 1176 | Explain the management of post-operative chest pain and arrhythmias. | | 1177 | Describe factors which can lead to abnormal bleeding post- operatively, and discuss their prevention and management. (a) surgical site—inherited and acquired factor deficiencies, DIC, transfusion reactions, operative technique (b) gastroduodenal (i.e., stress ulcerations) | | 1178 | Discuss disorders of alimentary tract function following laparotomy which may produce nausea, vomiting, and/or abdominal distension. (a) paralytic ileus (b) acute gastric dilatation (c) intestinal obstruction (d) fecal impaction | | 1179 | Outline precipitating factors and treatment of the following post-operative metabolic disorders: (a) hyperglycemia (b) adrenal insufficiency (c) thyroid storm | | 1180 | Discuss the contributing factors and management of external gastrointestinal fistulas. | | 1181 | Describe the factors that can give rise to alterations in cognitive function post-operatively, including their evaluation and treatment. (a) hypoxia (b) peri-operative stroke (c) medication effects (d) metabolic and electrolyte abnormalities (e) functional delirium (f) convulsions | | 1182 | Conduct a focused physical examination to include mental status changes, lungs, heart, and abdomen. | | 1183 | Assess surgical incision for wound complications. | | 1184 | Interpret findings on CXR indicative of atelectasis, pneumonia, pulmonary edema, and ARDS. | | 1185 | Insert NG tube and Foley catheter. | | 1186 | Explain that wound complications may be avoided through meticulous surgical techniques, by using peri-operative antibiotics for cleaning contaminated wounds, and by delaying closure of dirty wounds. | | 1187 | Explain how respiratory complications may be avoided by not smoking in advance of elective surgery, by encouraging coughing and deep breathing, by not using excessive analgesia, and by early post-operative ambulation. | | 1188 | Explain how oliguria may be avoided by administering adequate intravenous fluids and by assuring outflow. | | 1189 | Explain how to help prevent hypotension by avoiding hypovolemia, monitoring for arrhythmias, recognizing and treating infection early, and titrating medication doses carefully. | | 1190 | Outline techniques for helping to prevent bleeding at the surgical site. (a) Apply meticulous operative techniques. (b) Screen for factor deficiencies. (c) Give platelets and fresh frozen plasma for massive blood loss. (d) Avoid DIC by preventing infections and treating them early. | | 1191 | Keep gastric pH neutral to help avoid gastroduodenal bleeding. | | 1192 | Use a nasogastric tube, stool softeners, and cathartics when necessary to assist in avoiding alimentary tract dysfunction. | | 1193 | Avoid using too large infusions of glucose, monitor diabetics carefully, and administer insulin appropriately in order to help prevent hyperglycemia. | | 1194 | Control hyperthyroidism prior to surgery in order to help prevent thyroid storm. | | 1195 | Provide stress doses of corticosteroids when adrenals are chronically suppressed in order to help avoid adrenal insufficiency. | | 1196 | To help prevent alterations in cognitive function, avoid hypoxia and electrolyte imbalances and titrate medications carefully. | | |
| Blueprint ID | Course Goals | | 10387 | EPA 1 (AAMC): Gather a history and perform a physical examination
Linked Program Competencies
To This Course Goal: me-1 me-2 me-6 cm-1 cm-2 ha-1 pr-1 | | 10388 | EPA 2 (AAMC): Prioritize a differential diagnosis following a clinical encounter
Linked Program Competencies
To This Course Goal: me-4 me-6 cm-1 cm-2 cm-6 co-2 ha-1 ha-2 sc-1 sc-2 sc-3 pr-1 | | 10390 | EPA 4 (AAMC): Enter and discuss orders and prescriptions
Linked Program Competencies
To This Course Goal: me-5 me-6 cm-3 cm-4 cm-5 cm-6 co-2 co-3 ld-2 ld-3 ha-3 sc-2 pr-1 | | 10396 | EPA 10 (AAMC): Recognize a patient requiring urgent or emergent care and initiate evaluation
Linked Program Competencies
To This Course Goal: me-1 me-2 me-3 me-4 me-5 me-6 cm-1 cm-2 cm-3 cm-4 cm-5 cm-6 co-1 co-2 co-3 ld-1 ld-2 ld-3 ha-3 sc-1 sc-2 pr-1 | | 10397 | EPA 11 (AAMC): Obtain informed consent for tests and/or procedures
Linked Program Competencies
To This Course Goal: me-3 me-5 me-6 cm-1 cm-3 cm-4 cm-5 ld-2 ld-3 ha-1 ha-3 sc-2 sc-3 pr-1 | | 10398 | EPA 12 (AAMC): Perform general procedures of a physician
Linked Program Competencies
To This Course Goal: me-3 me-5 me-6 cm-1 cm-3 cm-4 cm-5 cm-6 co-1 co-3 ld-2 sc-1 sc-2 pr-1 | | 10399 | EPA 13 (AAMC): Identify system failures and contribute to a culture of safety and improvement
Linked Program Competencies
To This Course Goal: me-6 cm-6 co-1 ld-1 ld-3 ha-3 sc-1 sc-2 sc-3 pr-1 | | me-1 | Medical Expert
Perform a complete and accurate patient-centred history appropriate to the patient’s presentation. | | me-2 | Medical Expert
Perform a complete and accurate physical examination appropriate to the patient’s presentation. | | me-6 | Medical Expert
Apply knowledge of the clinical, socio-behavioural, and fundamental biomedical sciences relevant to a clinical problem. | | cm-1 | Communicator
Develop and maintain appropriate ethical and therapeutic relationships, rapport and trust with patients and their families. | | cm-2 | Communicator
Collect and synthesize accurate and relevant information, incorporating perspectives from patients and their families, colleagues and other health care professionals. | | ha-1 | Health Advocate
Identify the important determinants of health, risk factors for illness, interaction between the population and their physical, biological and social environment, and personal attributes. | | pr-1 | Professional
Demonstrate accountability to patients by applying best practices and adhering to high ethical standards. | | me-4 | Medical Expert
Develop a differential diagnosis and key clinical problem list following assessment of a patient. | | cm-6 | Communicator
Discuss effective strategies for communicating with third parties other than health care professionals. | | co-2 | Collaborator
Demonstrate effective consultation with other health care professionals to provide care for individuals, communities, and populations. | | ha-2 | Health Advocate
Identify public policies and trends that affect health locally, nationally, and globally, and barriers to access for populations, including persons with disabilities, the underserved and the marginalized. | | sc-1 | Scholar
Develop a plan for personal continued education. | | sc-2 | Scholar
Apply the principles of research, critical appraisal and evidence-based medicine to learning and practice. | | sc-3 | Scholar
Demonstrate facilitation of learning for health care professionals, patients and society as part of the professional responsibility. | | me-5 | Medical Expert
Develop a management plan for key clinical problems following assessment of a patient. | | cm-3 | Communicator
Discuss relevant health care information and management plans with patients and their families. | | cm-4 | Communicator
Develop a shared plan of care with patients, their families, and other health care professionals. | | cm-5 | Communicator
Demonstrate effective oral and written communication of information associated with a medical encounter. | | co-3 | Collaborator
Demonstrate respect for health care team members without bias (e.g., bias related to gender, ethnicity, cultural background or health care role). | | ld-2 | Leader
Apply evidence and management processes to effectively allocate health care resources. | | ld-3 | Leader
Describe the roles and responsibilities of physicians and governing bodies in the development and support of the health care system. | | ha-3 | Health Advocate
Assess and respond to issues in the Canadian health care system and advocate for patients at all levels. | | me-3 | Medical Expert
Formulate an initial plan of appropriate diagnostic and therapeutic procedures relevant to the patient’s presentation. | | co-1 | Collaborator
Demonstrate effective collaboration skills within the health care system. | | ld-1 | Leader
Identify strategies to effectively manage practice and career. |
| (042-1) ANEMIA | | (013) CARDIAC ARREST | | (015-1) BLEEDING, BRUISING | | (109-1) ABDOMINAL INJURIES | | (058-2) DELIRIUM | | (045) ACID-BASE ABNORMALITIES | | (099-1) HYPERNATREMIA | | (107-1) FEVER AND HYPERTHERMIA | | (079-2) HYPOKALEMIA | | (099-2) HYPONATREMIA | | (009-2) HYPOTENSION, SHOCK | | (103) SUBSTANCE-RELATED OR ADDICTIVE |
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