Post-Operative Assessment & Management

Last updated 20.09.12

 

Mx Present

 

 

Mx Top

Management

 

Surgery Related

-  Surgical site

-  Pain

-  Wound infection

-  Bleeding, haemorrhage

-  Wound dressings

-  Drains

-  Output: volume, fluid

-  Clamping vs suction

-  Remain/remove

-  Fluid Mx

-  Hypovolaemia

-  Blood transfusions

-  Analgesia

-  PCA, infusions..

-  +/- APS

 

Anaesthetic Related

-  Anaesthetic reaction

-  Prolonged immobility

-  Intubation & supine

-  Basal atelectasis: cough, sputum, dyspnoea, fever

-  Aspiration pneumonia

 

Post Op Considerations

-  Anticoagulation

-  May start anti-coagulation immediately or within hours dependant on Sx

-  Enoxaparin often commenced 6hrs post op (12hrs if spinal anaesthetic)

-  If high risk of bleeding & require anticoagulation use Heparin/Infusion

-  More easily reversed

-  Consideration of recommencing Warfarin

-  Urine output

-  Oliguria

-  IDC

-  Vascular stasis

-  DVT & PE --> post op prophylaxis

-  AMI

-  Infection

-  IDC: UTI

-  Pneumonia

 

Diet

-  Hypoglyceamia

-  Ceasing Insulin Dextrose infusions

-  Meals

-  +/- NBM post bowel resection until bowel motion or flatus

-  Other Sx Day 1 cear fluids --> Day 2-3 diet as tolerated

 

 

 

Top

Presentations

 

-  Fever

-  Nausea & vomiting

-  Haemorrhage

-  Decreased urine output

-  Hypotension

-  Hypertension

-  Pain

-  Confusion

-  BNO

-  Rhabdomyolysis

 

Fever

-  Day 1

-  Mostly atelectasis

-  Day 3

-  ? infection: pneumonia, wound, IV site, UTI

-  Septic screen: CXR, Urine MCS, wound swab

-  Blood cultures if temp >38

-  Day 5

-  ? DVT, anastomotic leak, intra-abdo collection

 

Post-op Nausea & Vomiting

-  Nausea & vomiting very common, esp w ass opiate analgesia

-  Assess for underlying cause

-  Bowel obstruction

-  Ileus

-  Meds: opiates

-  Consider: NGT, AXR

-  Anti-emetics

-  Metocloperamide (Maxalon)

-   1st line Mx

-   0.4-0.5 mg/kg IV

-  Max < 30kg 10mg, > 30kg 20mg

-   If effective 0.2mg/kg IV 4/24 PRN

-   If not effective by 30min -->

-  Promethazine (Phenergan)

-   2nd line Mx

-   0.5mg/kg IV

-  Max 12.5mg/dose

-   If effective 6/24 PRN

-   If not effective by 30min -->

-  Ondansetron (Zofran)

-   0.1mg/kg IV

-  Max 4mg

-  Severe refractory

-   Droperidol

-   Dexamethasone

 

-  BNO (Bowels Not Open)

-  Careful use of laxatives post op

-  DO NOT use unless consult w surgeon/reg