DPD: The acutely ill surgical patient

Question 1

What is meant by the term “acutely unwell”?

Answer 1

New onset condition
Deranged physiology
Unstable
Shocked

Question 2

What is shock?

Answer 2

Life-threatening condition of circulatory failure, causing inadequate O2 delivery to meet cellular metabolic needs + O2 consumption requirements

Question 3

What are the 4 broad types of shock?

Answer 3

Hypovolaemic: inadequate circulating volume to maintain perfusion
Distributive: changes in circulatory capacity e.g 3rd spacing/ gross vasodilation
Cardiogenic: pump failure
Obstructive: heart physically able to pump enough but there is an obstruction

Question 4

Give examples of causes of the 4 types of shock

Answer 4

Hypovolaemic: dehydration + haemorrhage
Distributive: Sepsis + neurogenic
Cardiogenic: arrhythmia + pump failure
Obstructive: tamponade + pneumothorax

Question 5

Where may we find acutely unstable patients?

Answer 5

New presentation in ED, acutely unwell resulting from surgical condition
Post operative surgical patient on the ward

Question 6

What can cause an acutely unwell patient with a surgical condition to present in ED?

Answer 6

Inflammation/ infection
Perforation 
Obstruction
Haemorrhage
Ischaemia
Trauma

Question 7

What can cause a stable post-operative patient to become acutely unwell?

Answer 7

Specific causes: directly relate to surgery (only arise because of that type of surgery)
General: indirect consequence

Question 8

What type of shock is a patient with a perforated duodenal ulcer in?

Answer 8

Distributive shock

Question 9

What is the most common cause of a high temperature, hypoxia and tachycardia 2 days after surgery?

Answer 9

Ateclasis