Emergency- Post-op TURP Flashcards
How would you assess a patient with bleeding from their 3-way catheter after a TURP?
I would see the patient immediately. If I was phoned by the nurse or staff looking after patient to keep patient fasted, and of junior doctor on the ward to start assessing the patient in ABCDE manner.
On arrival to ward, assess patient in ABCDE, ensure oxygen given, wide bore access and bloods to take away- FBC, Coag, Xmatch 3 units, U&Es, CRP, VBG for lactate.
If hypovolemic then start stat bag fluids while waiting for blood results from VBG and RBC
Address the abdomen and catheter. Unblock the catheter with washout until clots clear. Keep on fast irrigation.
consider traction of catheter- inflate the balloon to 40-50ml. traction of catheter over the bed at 20 minute intervals with 5 minute breaks to avoid bladder neck ischemia.
If not working after 2-3 attempts of traction or unstable despite fluid resus then patient needs to go to theatre. Contact oncalls cons and anaesthetics, then theatre team. Consent patient to go back to theatre. Consider bed availability in HDU or ICU and highlight unwell patient to bed manager.
Theatre- washout and re-do TURP +/- proceed.
if bleeding not under control then may need open procedure to stop bleeding.
What are stages of haemorrhagic shock?
ATLS demonstrates 4 classes of shock:
Class 1: 15% blood loss, 750ml blood loss, HR <100 and BP normal, RR 14-20, pulse pressure normal, GCS normal
Class 2: 15-30% blood loss, 750-1500ml blood loss, HR 100-120, BP normal, RR 20-30, pulse pressure decreased, GCS normal
Class 3: 30-40% blood loss, 1500-2000ml bloods loss, HR 120-140, BP decreased, RR 30-40, pulse pressure decreased, GCS decreased
Class 4: >40% blood loss, >2000mL blood loss, HR >140, BP decreased RR>40, pulse pressure decreased, GCS decreased
