Idiopathic
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A 37-year-old man has emergency surgery to repair a radial artery, during which he has to be intubated. 24 hours post surgery he experiences dyspnea, with altered O2sat. What is the most likely cause?
a. bronchopneumonia from Streptococcus pneumoniae
b. lobar pneumonia from Klebsiella pneumoniae
c. bronchiectasis
d. pulmonary embolism
e. acute right-heart failure
f. pleural effusion
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| asmi
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is it D :?:
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nope: PE suspected if 5 days post-surgery
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| Idiopathic
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Sorry, that above Guest is me, the OP.
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| asmi
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B :?:
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| meg
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I'd day e ) acute right heart failure
she aspirated or trauma to the tracheo bronchial tree due to intubation :arrow: tracheobronchial obstruction, raised intra bronchial pressure, increased pulmonary art pressure, acute cor pulmonale.
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| Idiopathic
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Nope the answer is B
MCC of dyspnea 12-24 hours after surgery is bronchiectasis
MCC of dyspnea 3-5 days after surgery is lobar pneumonia
MCC of dyspnea 5 days after surgery is PE (notice wheezing)
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| asmi
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also the most common organism causing lung infection through ventilator is klebsiella pneumoniae.
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| asmi
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it was a good question 
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Shouldn't the answer be C? since it's 24 hrs?
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| Ouli Maty
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Good point.
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deep breathing...
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| Idiopathic
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No...the idea behind the question is that the disease process has already occurred, and the symptoms are coming on. I suppose I should have said 'within 24 hours'. But the test is to know the most common post-surgical respiratory problems. I also should have mentioned that he was removed from intubation after surgery. But it does take ~3 days for an infection to develop and 5 days for PE, I just think that the area between 2-3 days is cloudy.
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| Idiopathic
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I am so sorry, you all...the answer is C. Bronchiectasis. DO NOT MISS THIS BECAUSE OF ME! I thought bronchiectasis was B, not C.
THE ANSWER IS C!!
:oops: :oops: :oops: :oops:
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| asmi
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yes you should have said with in 24 hrs.
Good point maty!
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| asmi
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good question idiopathic
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| meg
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how can bronchiectasis set in so fast? within 24 hours, is it really possible? what is the trigger that causes it so soon?
In most of conditions (like cystic fibrosis, chronic infection), there is a chronic atrophy and weakening of the walls. I never heard of acute bronchiectasis!
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| asmi
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meg , idopathic says he did mistake ,he should have written 3 days or 4 days after surgery.
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| Idiopathic
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No, bronchiectasis in the first 24 hours. Mucous plugs from anesthetic and decreased respiration. Always try to get them to cough early.
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| mjl1717
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1) As humans we all err (make mistakes),as seen here
2) According to idiopathic- he wrote he states it should have been written within 24hrs.
3) megs suspicion is correct-bronchietasis so fast? By definition bronchietsis is due to airway dilation due to CHRONIC necrotizing infection
4) * "ectasis" is part of the confusion, I think what he means is pt had
atelectasis due to surgery-as I remember from my surgical rotation
"most common cause of dyspnea after surgery within 24hrs
5) * This sounds feasible because[ obstrucion /resorption atelectasis] is
collapse of lung due to resorption of air
6) Anatomically atelectasis is the opposite of bronchiectasis :idea: :shock:
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| Idiopathic
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:oops: having realized this about two hours ago and just now getting home, i have to say that, to my chagrin, it was a mistake. I do know the difference between bronchiectasis and atalectasis, and I apologize for all the confusion. Resorption atalectasisis the most common cause of fever and dyspnea 24-36 hours after surgery, and the other situations are correct.
Bronchiectasis is, of course, a chronic condition, often seen in CF.
I am so sorry :oops: :oops: :oops:
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| asmi
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thanks mjl
you r right :idea:
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| meg
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Idiopathic,
no problem, dont feel embarassed. Now none of us will forget the within 24 hour complication of intubation 
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