post-operative complications mr j lambert bsc. mbchb mrcs
TRANSCRIPT
Post-operative Complications
Mr J Lambert BSc. MBChB MRCS
Contents
• Introduction
• Classifications
• Case study 1
• Case study 2
• Case study 3
• Case study 4
• Quiz
• Summary
Introduction
“all expected/unexpected adverse events from leaving theatre”
Classifications
• Immediate/Early/Late
• Systemic: neurological/respiratory/cardiovascular/gastro-intestinal/urological/endocrine/haematological
Case Study 1
• you are the surgical F1(in 2 years time)
• 21 yr old female, 5 hrs post lap chole: tachycardic (110), cool peripheries, BP:90/50, Urine output 30mls/hr, complaining of abdo pain
• How would you manage this patient?
CCrISP (Care of the Critically ill Surgical Patient (Royal College of Surgeons)
Case Study 1
• you are the surgical F1(in 2 years time)
• 21 yr old female, 5 hrs post lap chole: tachycardic (110), cool peripheries, BP:90/50, Urine output 30mls/hr, complaining of abdo pain
• How would you manage this patient?
Haemorrhagic Shock
Parameters I II III IV
Bloods loss(ml)
<750 750-1500 1500-2000 >2000
Blood loss(%) <15 15-30 30-40 >40
Heart rate <100 >100 >120 >140
Blood Pressure
normal orthostatic hypotension severe hypotension
Urine output(ml)
>30 20-30 5-15 negligible
CNS symptoms
normal anxious confused obtunded
what you may see?
Case Study 2
• In 4 years time you are the surgical SHO on a busy colorectal firm
• You are called to see a 54 yr old man post anterior resection for rectal cancer.He is 2 days post op, abdomen is distended, nurse reports 1L vomiting. not passing flatus or opening bowels yet.
• How would you manage this patient?
CCrISP (Care of the Critically ill Surgical Patient (Royal College of Surgeons)
you order an abdominal film
do not confuse with
Case study 3
• your F2 colleague has asked you to chase the bloods for the previous colorectal patient. It is now day 6 and the ileus has resolved. He was ready for discharge today but has suddenly spiked a temp of 38. His abdomen has become peritonitic.
• Bloods: WCC:23 CRP:300 Creat :200 Urea:9
• How would you manage this patient?
CCrISP (Care of the Critically ill Surgical Patient (Royal College of Surgeons)
Your Registrar asks you to book a CT
Case Study 4
• Your patient is managed conservatively. It is now day 25 of his enhanced recovery? His pre-sacral collection is drained radiologically. He has a long course of antibiotics and is now fit for discharge.
• He has been complaining of diarrhoea and you notice a fruity, sickly smell and his abdominal pain has returned
• How would you manage this patient?
CCrISP (Care of the Critically ill Surgical Patient (Royal College of Surgeons)
Quiz (Spot post-operative complication diagnosis)
Summary
• Be able to classify post-op complications• Think systematically (ABCDE)• Early basic management saves lives
Thanks
• Questions• Email: [email protected]