Post-operative

Question 1

What is NEWS in post-operative care?

Answer 1

National Early Warning Score to recognise clinical deterioration.

Question 2

What physiological parameters are measured in NEWS? (x6)

Answer 2

RR, Sats, temp, SBP, HR, level of consciousness. Once a score is derived, a patient may be escalated.

Question 3

How is NEWS calculated?

Answer 3

Parameters aggregated. Magnitude of score for each parameter reflects how seriously the parameter varied from the norm.

Question 4

How is NEWS interpreted?

Answer 4

• LOW CLINICAL RISK: score between 1 and 4. Increase NEWS frequency and contact nurse who determines escalation.
• MEDIUM CLINICAL RISK: score more than 3 in one parameter or 5-6. Increase NEWS frequency, inform medical team and clinician review.
• HIGH CLINICAL RISK: score more than 6. Emergency assessment.

Question 5

How is SIRS (severe inflammatory response syndrome e.g.., sepsis) recognised?

Answer 5

Two or more of: temperature >38 or <36, HR >90, RR >20, or WBC >12000 or <4000.

Question 6

How is sepsis managed? (x7)

Answer 6

1. TO BE COMPLETED WITHIN 3 HOURS: Measure lactate level
2. Obtain blood cultures prior to antibiotic administration
3. Administer broad spectrum antibiotics
4. Administer 30 ml/kg crystalloid for hypotension or lactate >4mmol/L.
5. TO BE COMPLETED WITHIN 6 HOURS: Vasopressors for hypotension that does not respond to initial fluid resuscitation. Maintain at least 65mmHg MAP.
6. Persistent hypotension: reassess volume status and tissue perfusion
7. Re-measure lactate is lactate initially elevated.

Question 7

How do you manipulate ventilation in exubation? (x2)

Answer 7

Aim to bring back respiratory drive by: (1) Increase CO2 by decreasing tidal volume or/and decreasing RR = decreased minute ventilation = increased CO2 and increased respiratory drive. (2) OR stop ventilation entirely, but not often as hypoxia risk.