17.5 URTI Flashcards
A 5-year-old patient presents for
a myringotomy and
grommet insertion as a day case.
During your preoperative assessment,
you notice that the patient has a nasal discharge.
a) Why would it be inappropriate to cancel the operation on the basis of this information alone? (25%)
There are consequences to such a cancellation:
» Inefficient list usage.
> > Wasted time off school for child.
> > Delayed surgery resulting in
ongoing hearing issues in child.
May impact on education.
> > Wasted parent’s time off work,
financial loss.
> > Loss of trust between parents/child
and hospital, especially if surgery
later takes place with runny nose still.
b) List the features in the history (35%) that might cause you to postpone the operation due to an increased risk of airway complications in this patient.
History:
» Fever.
> > Unwell in self, too unwell for school,
parent states that child is unwell.
> > Loss of appetite.
> > Shortness of breath.
*» Sore throat.
> > Cough.
> > Sputum production.
> > Purulent nasal discharge.
*» Significant comorbidities such as obstructive sleep apnoea, severe asthma, cardiac condition.
List the features in the examination (25%) that might cause you to postpone the operation due to an increased risk of airway complications in this patient.
Examination:
» Fever.
> > Listless, unwell.
> > Tachypnoea or other signs of respiratory distress.
> > Purulent nasal discharge.
> > Crackles on auscultation.
> > Tachycardia.
> > Delayed capillary refill.
c) What social factors would preclude this child’s treatment as a day case? (15%)
> > No telephone.
> > Poor housing conditions.
> > No private transport.
> > Distance more than one hour from hospital.
> > Parents unable or unwilling to
care for child postoperatively.
