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/ga
strointestinal/urological/endocrine/haematologi
cal
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)
Immediate management
ABCDE
Full Patient Assessment
chart review, history, examination,
results, scans
Decide and
Plan
Stable Patient
(Daily Management
Plan)
Unstable
Patient/Unsure(Dia
gnosis Required)Specific
Investigations
Definitive
Care(Medical,
Surgical,
Radiological)
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)
Immediate management
ABCDE
Full Patient Assessment
chart review, history, examination,
results, scans
Decide and
Plan
Stable Patient
(Daily Management
Plan)
Unstable
Patient/Unsure(Dia
gnosis Required)Specific
Investigations
Definitive
Care(Medical,
Surgical,
Radiological)
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)
Immediate management
ABCDE
Full Patient Assessment
chart review, history, examination,
results, scans
Decide and
Plan
Stable Patient
(Daily Management
Plan)
Unstable
Patient/Unsure(Dia
gnosis Required)Specific
Investigations
Definitive
Care(Medical,
Surgical,
Radiological)
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)
Immediate management
ABCDE
Full Patient Assessment
chart review, history, examination,
results, scans
Decide and
Plan
Stable Patient
(Daily Management
Plan)
Unstable
Patient/Unsure(Dia
gnosis Required)Specific
Investigations
Definitive
Care(Medical,
Surgical,
Radiological)
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: joellambert@doctors.org.uk