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Post-operative Complications

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.

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Post-operative Complications

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  1. Post-operative Complications Mr J Lambert BSc. MBChB MRCS

  2. Contents • Introduction • Classifications • Case study 1 • Case study 2 • Case study 3 • Case study 4 • Quiz • Summary

  3. Introduction “all expected/unexpected adverse events from leaving theatre”

  4. Classifications • Immediate/Early/Late • Systemic: neurological/respiratory/cardiovascular/gastro-intestinal/urological/endocrine/haematological

  5. 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?

  6. CCrISP (Care of the Critically ill Surgical Patient (Royal College of Surgeons)

  7. 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?

  8. Haemorrhagic Shock

  9. what you may see?

  10. 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?

  11. CCrISP (Care of the Critically ill Surgical Patient (Royal College of Surgeons)

  12. you order an abdominal film

  13. do not confuse with

  14. 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?

  15. CCrISP (Care of the Critically ill Surgical Patient (Royal College of Surgeons)

  16. Your Registrar asks you to book a CT

  17. 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?

  18. CCrISP (Care of the Critically ill Surgical Patient (Royal College of Surgeons)

  19. Quiz (Spot post-operative complication diagnosis)

  20. Summary • Be able to classify post-op complications • Think systematically (ABCDE) • Early basic management saves lives

  21. Thanks • Questions • Email: joellambert@doctors.org.uk

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