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The Unwell Surgical Patient
Summary
This vital teaching session for medical professionals, "The Unwell Surgical Patient," covers a comprehensive set of topics ranging from investigations, nutrition, fluid balance, drugs and their analgesia, to Physiotherapy, the usage of drains and tubes, transportation to different levels of care, specialist opinions, and optimal methods of communication. Using real-world patient cases, attendees will learn to systematically assess patients, develop resuscitation strategy, communicate effectively within team, and measure intervention effectiveness. This course underscores the importance of prompt, simple actions to save lives and prevent complications, making it an absolute must for those aiming to enhance their surgical patient care skills.
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Description
Learning objectives
- To recognize the interpretations of typical and atypical findings in various medical investigations including blood tests and radiological scans for the unwell surgical patient.
- To understand the nutritional requirements of unwell surgical patients and master the decision making for route of nutrition delivery.
- To assess and analyze fluid balance in surgical patients, including the interpretation of input/output charts and the management of fluid and electrolyte imbalances.
- To acquire knowledge about commonly used medications in surgical practice, including analgesics and drugs for prophylaxis and co-morbid diseases.
- To develop effective communication skills with the patient's care team, including documentation, consultation request to specialists, and discussion with those at higher levels of care.
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The Unwell Surgical Patient• Investigations (bloods, radiological) • Nutrition (route, requirements) • Fluid balance • Drugs and analgesia (treatment, prophylaxis, co-morbid disease) • Physiotherapy • Drains and tubes • Moving to higher / lower levels of care • Specialist opinions • Communication (documentation, nursing staff, senior colleagues, NOK)ABCDE 2 1 3 6 4 5 Day 1 post Panos’ birthday – he is admitted to ED with Case1 epigastric abdominal pain and vomiting after consuming a large amount of birthday cake the night before. PMH – NilSYSTEMIC & LOCAL Pseudoaneurysm / haemorrhageCase 2 44M - Day 5 Post Laparoscopic appendicectomy Drain came out Day 2. PMH - BMI 32, T2DM on metformin. Urine output 10m/hr. Worsening abdominal pain.Case courtesy of Henry Knipe, Radiopaedia.org, rID: 52391Case 2 80F – with PRB and abdominal pain Fast bleeped to ED Resus as passed 2x large volume bleeds ~500ml PMH – AF on apixaban, hypertension, OA Performance status 2Major haemorrhage Checklist q Request labs - including FBC, clotting, crossmatch, VBG q Regularly re-check q Do not delay treatment q Optimise communication q Declare major haemorrhage protocol q Contact and designate key personnel – senior, transfusion technician, anaesthetist, duty haematologist, scribe q Restore blood volume q To maintain tissue perfusion and oxygenation q Large bore cannulae, IO q Achieve haemostasis q Definitive treatment of surgical/obstetric/traumatic cause of bleeding q Correct coagulopathy with blood components 1:1:1:1 ratio of PRBC:FFP:Plt:Cryo q Consider reversal of anticoagulants q Source of bleedingLGIB Oakland Guidelines Risk Score (UK BSG 2019)Circulatory shockCase 4 70M – Day 5 post elective open sigmoid colectomy BNO since procedure Slow to progress PMH – BPH, HTN, T2DM on metformin, previous lap appendicectomyCase courtesy of Ian Bickle, Radiopaedia.org, rID: 148273Key Points ● Systematic assessment reduces omissions/errors ● Need for simultaneous assessment and resuscitation ● Frequent re-assessment – has your intervention been effective? ● Communication at all levels “Prompt, simple actions save lives and prevent complications”