There are signs of reduced air entry at the right base but the CXR doesn’t show an obvious
abnormality. What is the most appropriate management strategy?
a. Cefuroxime PO
b. Ceftriaxone IV
c. Chlorpheniramine PO
d. Chest physiotherapy
e. Reassure
answer: D
ATELECTASIS
• comprises 90% of post-operative pulmonary complications
Clinical Features
• low-grade fever on POD #1, tachycardia, crackles,
decreased breath sounds, bronchial breathing,
tachypnea
Risk Factors
• COPD, smoking, obesity, elderly persons
• upper abdominal/thoracic surgery, oversedation,
significant post-operative pain, poor
inspiratory effort
Treatment
• pre-operative prophylaxis
- smoking cessation (best if >8
wk pre-operative)
- provide incentive spirometer and
instruct how to use
• post-operative prophylaxis
- incentive spirometry, deep
breathing exercise, chest physiotherapy, intermittent positivepressure
breathing
- selective NGT decompression
after abdominal surgery
- short-acting neuromuscular
blocking agents
- minimize use of respiratory
depressive drug, good pain control, early ambulation
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