Post-operative patient on the Ward Flashcards
Initial?
Introduce yourself
Confirm the patient details
Gain consent to proceed
I would approach the patient using a structured A-E approach according to Advanced Life Support guidelines, initiating immediate management as required and escalating appropriately.
One A-E complete and patient stable, escalate to seniors
What would you do while waiting for seniors if pt needs to return to theatre
Book patient onto emergency theatre list
Inform theatre co-ordinatory and on-call anaesthetist
Approach for post-op patient
SHE BOXED
Summary of History and Examination findings
Bedside Tests and Bloods
Orifices
Xray, imaging and special tests
Escalation plan
DNACPR Status
Issues
Impression
Plan
How do you summarise History?
AMPLE Allergies Medications PMHx Last eaten/had something to drink (6/2 rule) Events leading up to admission/current situation/current positive exam findings): Admission, PC SUurgery Operation note Post-op instruction REvocer
- Review operation note and anaestehtic chart:
- was operation straightforward
- what were post-op instructions
- what drugs were used during op
- how has patient been in recovery
How do you summarise examination
Focussed examination findings of relevant system
B
Bedside Tests/Bloods
BP ECG SaO2 Temperature RR HR
Bloods: FBC, U&E, LFT Clotting, G&S, XM Blood cultures Gases - ABG/VBG
LOOK FOR TREND IN VALUES AND OBS
O
Orifices
Sputum culture Swab results URine culture Urine output Stool output Drain output Fluid balance
Work from head downwards
Trend in drain/catheter output
X
Xray/imaging/specials
X-ray US CT MRI Endoscopy
E
Escalation plan
HDU? ITU? – NIV, inotropic support, intubation
Who should you escalate within your team?
What other specialities:
Critical care team
Med reg
Anaesthetics
D
DNACPR Status
IS there a valid DNACPR in place
Highlight to seniors to discuss
61-year-old male who is day 3 post laparoscopic cholecystectomy. He has spiked a temperature of 38 degrees celsius and is tachycardic at 120bpm.
I would approach the situation using a structured A-E approach, initiating immediate management to stabilise the patient. If required, I would also escalate appropriately.
I would take a history, focusing on the patient’s allergies, medications, past medical history and when they had last eaten or had something to drink.
In addition, I would clarify the recent events of the hospital stay, including admission date, the current diagnosis and any operation that has taken place.
With regard to the surgery, I would want to review the operation note for post-operative instructions and evidence of complications. In addition, I would want to read over the most recent ward review.
Given that this patient has undergone gastrointestinal surgery, I would focus my examination on their gastrointestinal system
I would review the patient’s recent bedside observations, input/output charts, imaging and laboratory results (including blood tests and microbiology results). I would also ensure the patient had a valid group and save, should they need to return to theatre.
If the patient was potentially in need of HDU/ITU input, I would clarify the escalation plan with senior team members and ensure it was discussed with the patient and family as appropriate. I would also check if a DNA CPR form was present and if not, consider if this needed further discussion with senior team members and the patient/family.
Based on the findings of my assessment, I would then formulate a differential diagnosis and management plan accordingly.
PRe-operative risk factors?
Diabetic patients
Obese patients
More likely to develop surgical site infections and wound breakdown
Peri-operative risk factors
Operation open - more likely to breakdown
Foreign material used - infection
Post-operative risk factors?
Antibiotics post-op?
Psot-op instructions?
What are patient risk factors?
Obesity DM Steroids Immunosuppression Malnutrition
