The post-operative patient needs management of various issues including pain, delirium, respiratory compromise, cardiovascular issues, and infection. Major post-op issues stem from the body's stress response to surgery, including systemic inflammation, catabolism, insulin resistance, and fluid/electrolyte changes. Care requires monitoring for signs of organ dysfunction and providing support for individual organ systems while addressing surgery-specific concerns.
This document provides information on different types of shock, including definitions, pathophysiology, stages, types, treatments, and case examples. It defines shock as a state of inadequate tissue perfusion and oxygen delivery. The main types discussed are hypovolemic, cardiogenic, distributive (septic), and obstructive shock. It outlines the stages of shock from compensated to decompensated to irreversible. Case examples are provided to demonstrate how to identify the type of shock based on presenting signs and symptoms. Initial treatment approaches focus on oxygenation, ventilation, fluid resuscitation and vasoactive drugs. Prognosis depends on the cause, with septic shock having higher mortality.
1. The document discusses pediatric shock, including its definition, types, pathophysiology, signs, investigations, and management.
2. The main types of shock discussed are hypovolemic, cardiogenic, distributive, obstructive, and septic shock.
3. Management of shock involves rapid recognition and resuscitation through fluid administration, vasopressors, and addressing metabolic abnormalities to restore adequate tissue perfusion.
Another Critical Care Collaborative Deep Dive into the assessment and management of shock. Covers classification of shock, diagnosis, serial assessment methods and management.
Shock is a condition where inadequate blood flow to tissues results in poor delivery of oxygen and nutrients. This can lead to cellular hypoxia and death, progressing to organ dysfunction and death without treatment. Adequate blood flow requires an effective cardiac pump, circulatory system, and sufficient blood volume. Septic shock is caused by infection leading to toxins that damage tissues and blood vessels, reducing blood flow. It most commonly affects those with weakened immune systems. Treatment focuses on rapid restoration of blood flow through fluids, antibiotics, and vasoactive drugs, as well as organ support like mechanical ventilation or dialysis.
In 2017, the number of road traffic accidents (RTA) deaths in India was at 150k. 50% die because of haemorrhage and 100% die within 24 hrs. if not intervened. A guide to manage such incidents in pre-hospital scenario and in an ED.
Cardiogenic shock is a low cardiac output state resulting from inadequate tissue perfusion despite adequate left ventricular filling pressures. It is usually caused by acute myocardial infarction which accounts for about 80% of cases. Clinically, it is defined by sustained hypotension with signs of hypoperfusion and a systolic blood pressure less than 90 mmHg for at least 30 minutes or the need for vasopressor/inotropic support. The mortality rate for cardiogenic shock remains high at over 80% despite advances in management. Early diagnosis and aggressive treatment including revascularization, inotropic support, and mechanical circulatory support are aimed at improving outcomes.
Basics of Shock and its management. Compentency and SLO based learning for undergraduate medical training (MBBS)
Check out the lecture by clicking on the link below
https://www.youtube.com/watch?v=J5m4kh4FO7k
Shock its pathopysiology and managementSHAKIL JAWED
This document discusses shock, including definitions, types, causes, pathophysiology, diagnosis, and treatment. It defines shock as a state of low tissue perfusion from inadequate oxygen and glucose delivery. The main types of shock discussed are hypovolemic, cardiogenic, obstructive, distributive, and septic shock. Treatment involves identifying and treating the underlying cause, restoring circulating blood volume and tissue perfusion through fluid resuscitation, and providing vasopressor support if needed to maintain blood pressure. Goals of resuscitation are optimizing oxygen delivery while avoiding fluid overload.
This document provides information on different types of shock, including definitions, pathophysiology, stages, types, treatments, and case examples. It defines shock as a state of inadequate tissue perfusion and oxygen delivery. The main types discussed are hypovolemic, cardiogenic, distributive (septic), and obstructive shock. It outlines the stages of shock from compensated to decompensated to irreversible. Case examples are provided to demonstrate how to identify the type of shock based on presenting signs and symptoms. Initial treatment approaches focus on oxygenation, ventilation, fluid resuscitation and vasoactive drugs. Prognosis depends on the cause, with septic shock having higher mortality.
1. The document discusses pediatric shock, including its definition, types, pathophysiology, signs, investigations, and management.
2. The main types of shock discussed are hypovolemic, cardiogenic, distributive, obstructive, and septic shock.
3. Management of shock involves rapid recognition and resuscitation through fluid administration, vasopressors, and addressing metabolic abnormalities to restore adequate tissue perfusion.
Another Critical Care Collaborative Deep Dive into the assessment and management of shock. Covers classification of shock, diagnosis, serial assessment methods and management.
Shock is a condition where inadequate blood flow to tissues results in poor delivery of oxygen and nutrients. This can lead to cellular hypoxia and death, progressing to organ dysfunction and death without treatment. Adequate blood flow requires an effective cardiac pump, circulatory system, and sufficient blood volume. Septic shock is caused by infection leading to toxins that damage tissues and blood vessels, reducing blood flow. It most commonly affects those with weakened immune systems. Treatment focuses on rapid restoration of blood flow through fluids, antibiotics, and vasoactive drugs, as well as organ support like mechanical ventilation or dialysis.
In 2017, the number of road traffic accidents (RTA) deaths in India was at 150k. 50% die because of haemorrhage and 100% die within 24 hrs. if not intervened. A guide to manage such incidents in pre-hospital scenario and in an ED.
Cardiogenic shock is a low cardiac output state resulting from inadequate tissue perfusion despite adequate left ventricular filling pressures. It is usually caused by acute myocardial infarction which accounts for about 80% of cases. Clinically, it is defined by sustained hypotension with signs of hypoperfusion and a systolic blood pressure less than 90 mmHg for at least 30 minutes or the need for vasopressor/inotropic support. The mortality rate for cardiogenic shock remains high at over 80% despite advances in management. Early diagnosis and aggressive treatment including revascularization, inotropic support, and mechanical circulatory support are aimed at improving outcomes.
Basics of Shock and its management. Compentency and SLO based learning for undergraduate medical training (MBBS)
Check out the lecture by clicking on the link below
https://www.youtube.com/watch?v=J5m4kh4FO7k
Shock its pathopysiology and managementSHAKIL JAWED
This document discusses shock, including definitions, types, causes, pathophysiology, diagnosis, and treatment. It defines shock as a state of low tissue perfusion from inadequate oxygen and glucose delivery. The main types of shock discussed are hypovolemic, cardiogenic, obstructive, distributive, and septic shock. Treatment involves identifying and treating the underlying cause, restoring circulating blood volume and tissue perfusion through fluid resuscitation, and providing vasopressor support if needed to maintain blood pressure. Goals of resuscitation are optimizing oxygen delivery while avoiding fluid overload.
1. Shock is characterized by inadequate oxygen delivery to tissues due to a mismatch between supply and demand. Compensatory mechanisms include increased heart rate and vascular tone, but signs include tachycardia, pale skin, prolonged capillary refill time, and hypotension.
2. Shock is classified based on severity (compensated vs. hypotensive) and etiology (hypovolemic, distributive, cardiogenic, obstructive). Management involves rapid fluid resuscitation and treatment of the underlying cause.
3. Hemorrhagic shock results from blood loss that depletes circulating volume. Early identification, airway control, fluid resuscitation, and source control are crucial, as is following
This document provides an overview of shock and its management. It defines shock as an acute medical condition associated with a fall in blood pressure caused by events such as blood loss, burns, allergic reactions or sudden emotional stress. The causes of shock are discussed as cardiogenic, hypovolemic, neurogenic, anaphylactic and septic. Signs and symptoms and classification of hemorrhage are outlined. General management principles like airway maintenance, oxygen administration, IV fluids and blood transfusion are described. Surgical and local methods of hemorrhage control are also summarized. Finally, the spectrum of infections from bacteremia to septic shock and MODS as well as the treatment approach of antibiotics, source control
This document provides an overview of shock in children, including:
1. Definitions of shock and the pathophysiology involving reduced tissue perfusion and oxygen delivery.
2. The epidemiology and classifications of different shock types, including hypovolemic, distributive, cardiogenic, and obstructive shock.
3. Details on the causes, signs, symptoms, and stages of specific shock types like septic, hemorrhagic, and cardiogenic shock.
4. The goals of evaluating and managing shock in children, including rapid assessment of appearance, breathing, circulation, history, and physical exam findings.
This document discusses the pathophysiology, causes, and management of shock. Shock is defined as a state of circulatory insufficiency resulting in inadequate organ perfusion. There are several types of shock, including hypovolemic, vasodilatory, cardiogenic, neurogenic, and obstructive. The initial goals of management are to secure the airway, administer intravenous fluids and vasopressors to restore perfusion pressure and tissue oxygenation, and give antibiotics if infection is suspected. The ultimate treatment involves addressing the underlying cause while monitoring systemic and tissue parameters to guide resuscitation efforts until oxygen debt is repaid and aerobic metabolism is restored.
This document defines and classifies shock, discusses the pathophysiology of different types of shock, and outlines the clinical approach and management of shocked patients. Shock is classified into four main types: hypovolemic, cardiogenic, obstructive, and distributive. For each type of shock, the causes, mechanisms, clinical findings, specific investigations, and treatments are described. The document emphasizes the importance of the ABCDE (airway, breathing, circulation, disability, exposure) algorithm in the emergency clinical approach to shocked patients.
"Shock" is a multifaceted condition that can range from being mild to extremely fatal. This is a condition whose knowledge is a must for medical practitioners; especially the one in the field of Dentistry.
This document provides definitions and guidelines for the management of hemorrhagic shock. It defines hemorrhagic shock as reduced tissue perfusion resulting from excessive blood loss. Guidelines recommend rapid diagnosis and treatment of bleeding, optimizing oxygen delivery and volume through fluids and blood products. Early coagulopathy should be monitored and treated with plasma, fibrinogen, platelets and tranexamic acid. Definitive surgical or angiographic intervention is important when bleeding is uncontrolled.
Shock - Pathophysiology, Clinical Features & ManagementAnkit Sharma
1. Hemorrhagic shock is the most common cause of shock in surgical or trauma patients and results from blood loss that exceeds 15% of circulating volume.
2. Initial management of hemorrhagic shock involves identifying the source of bleeding, providing immediate resuscitation with fluids and blood products, and controlling hemorrhage.
3. Damage control resuscitation principles are followed, including permissive hypotension to limit blood loss and balanced use of crystalloids, colloids, platelets, and plasma to prevent coagulopathy.
1. Shock is defined as a systemic state of low tissue perfusion that is inadequate for normal cellular respiration. It occurs when there is insufficient delivery of oxygen and glucose to cells, causing cells to switch from aerobic to anaerobic metabolism. If perfusion is not restored, cell death ensues.
2. The main types of shock are hypovolemic, cardiogenic, obstructive, distributive, and endocrine shock. Hypovolemic shock, the most common type, is caused by blood or fluid loss. Cardiogenic shock results from cardiac dysfunction that reduces cardiac output.
3. The goals of shock resuscitation are to increase oxygen delivery, decrease oxygen demand, improve cardiac
Educative power-point presentation for students in paediatrics, paediatric critical care, neonatology, And trainees or fellows in paediatric critical care
Cardiogenic shock is a life-threatening condition caused by the heart's inability to pump enough blood to meet the body's needs, usually due to a severe heart attack damaging the heart muscle. Symptoms include increased respiratory rate, decreased heart rate, decreased urine output, and decreased consciousness. Treatment focuses on oxygenation, increasing systemic vascular resistance through vasopressors like epinephrine and norepinephrine, and improving heart contractility with medications that activate beta-1 receptors. Preventing cardiogenic shock involves maintaining a healthy heart through lifestyle.
Shock is defined as inadequate tissue perfusion resulting from reduced blood flow or oxygen delivery. There are four main types of shock: hypovolemic, cardiogenic, distributive, and obstructive. The management of shock involves treating the underlying cause, restoring circulating volume with intravenous fluids, and providing supportive care such as oxygen supplementation. Goals are to improve oxygen delivery and prevent end organ damage. Early recognition and treatment are important for successful management.
Definition of shock
Initial Assessment of shock – ABC
Types of Shock
Stages of Shock
Physiologic Determinants of Shock
Common Features of Shock
Work-up of shock
General Approach to management of shock
This document defines and discusses the pathophysiology of different types of shock: cardiogenic, obstructive, hypovolemic, and distributive. It notes that shock occurs when there is inadequate perfusion and oxygenation of cells, leading to cellular and organ dysfunction. The key signs of shock include tachycardia, hypotension, altered mental status, and decreased urine output. Early goal-directed resuscitation is important to prevent end organ damage and death, and should focus on airway management, oxygenation, fluid resuscitation, and treating the underlying cause.
1. Shock is defined as a state of low tissue perfusion resulting from inadequate oxygen and glucose delivery to cells. This causes cells to switch from aerobic to anaerobic metabolism, leading to cell death if not corrected.
2. The pathophysiology of shock involves simultaneous cellular, microvascular, and systemic changes including metabolic acidosis, organ ischemia, immune system activation, and sympathetic nervous system response.
3. Shock is classified based on its underlying cause as hypovolemic, cardiogenic, obstructive, distributive, or endocrine. Resuscitation priorities include addressing hypovolaemia with intravenous fluids before considering further treatment.
The document discusses shock pathophysiology and management. It defines shock as inadequate tissue perfusion leading to hypoxia. Oxygen delivery is determined by cardiac output and hemoglobin/oxygen saturation levels. The types of shock are classified as hypodynamic or hyperdynamic based on cardiac output. Treatment involves fluid resuscitation and vasopressors to support perfusion as needed.
The document discusses several common acute complications that can occur during hemodialysis treatments. It notes that hypotension occurs in 25-55% of patients and is the most frequent complication. Other common complications include muscle cramps (5-20% of patients), nausea/vomiting (5-15%), chest pain (2-5%), and back pain (2-5%). The document provides details on the causes, risk factors, prevention, and treatment of these complications, particularly hypotension and muscle cramps. It also discusses less common but potentially life-threatening issues like dialysis disequilibrium syndrome, air embolism, and seizures.
1. The document discusses various markers that can be used to define and assess low cardiac output, including lactate levels, mixed venous oxygen saturation, oxygen delivery and extraction ratio.
2. Treatment for low cardiac output syndrome focuses on improving contractility through the use of inotropic agents like calcium, dobutamine and milrinone, as well as vasodilators to reduce afterload like sodium nitroprusside.
3. The effects of various inotropes are discussed, noting that dopamine has limited benefit and epinephrine does not increase pulmonary or systemic vascular resistance like dopamine. Milrinone provides inotropic and vasodilatory effects with minimal increase in heart rate.
The post operative period begins after surgery and focuses on enabling successful recovery. It aims to reduce mortality, length of stay, and costs through quality care. Patients are monitored in the PACU or SICU by nurses. They assess vitals, consciousness, bleeding, pain/anxiety and more to detect complications and ensure stability for discharge. The goal is safe transfer from intensive recovery phases to continued recovery in step-down units or at home with instructions.
1. Shock is characterized by inadequate oxygen delivery to tissues due to a mismatch between supply and demand. Compensatory mechanisms include increased heart rate and vascular tone, but signs include tachycardia, pale skin, prolonged capillary refill time, and hypotension.
2. Shock is classified based on severity (compensated vs. hypotensive) and etiology (hypovolemic, distributive, cardiogenic, obstructive). Management involves rapid fluid resuscitation and treatment of the underlying cause.
3. Hemorrhagic shock results from blood loss that depletes circulating volume. Early identification, airway control, fluid resuscitation, and source control are crucial, as is following
This document provides an overview of shock and its management. It defines shock as an acute medical condition associated with a fall in blood pressure caused by events such as blood loss, burns, allergic reactions or sudden emotional stress. The causes of shock are discussed as cardiogenic, hypovolemic, neurogenic, anaphylactic and septic. Signs and symptoms and classification of hemorrhage are outlined. General management principles like airway maintenance, oxygen administration, IV fluids and blood transfusion are described. Surgical and local methods of hemorrhage control are also summarized. Finally, the spectrum of infections from bacteremia to septic shock and MODS as well as the treatment approach of antibiotics, source control
This document provides an overview of shock in children, including:
1. Definitions of shock and the pathophysiology involving reduced tissue perfusion and oxygen delivery.
2. The epidemiology and classifications of different shock types, including hypovolemic, distributive, cardiogenic, and obstructive shock.
3. Details on the causes, signs, symptoms, and stages of specific shock types like septic, hemorrhagic, and cardiogenic shock.
4. The goals of evaluating and managing shock in children, including rapid assessment of appearance, breathing, circulation, history, and physical exam findings.
This document discusses the pathophysiology, causes, and management of shock. Shock is defined as a state of circulatory insufficiency resulting in inadequate organ perfusion. There are several types of shock, including hypovolemic, vasodilatory, cardiogenic, neurogenic, and obstructive. The initial goals of management are to secure the airway, administer intravenous fluids and vasopressors to restore perfusion pressure and tissue oxygenation, and give antibiotics if infection is suspected. The ultimate treatment involves addressing the underlying cause while monitoring systemic and tissue parameters to guide resuscitation efforts until oxygen debt is repaid and aerobic metabolism is restored.
This document defines and classifies shock, discusses the pathophysiology of different types of shock, and outlines the clinical approach and management of shocked patients. Shock is classified into four main types: hypovolemic, cardiogenic, obstructive, and distributive. For each type of shock, the causes, mechanisms, clinical findings, specific investigations, and treatments are described. The document emphasizes the importance of the ABCDE (airway, breathing, circulation, disability, exposure) algorithm in the emergency clinical approach to shocked patients.
"Shock" is a multifaceted condition that can range from being mild to extremely fatal. This is a condition whose knowledge is a must for medical practitioners; especially the one in the field of Dentistry.
This document provides definitions and guidelines for the management of hemorrhagic shock. It defines hemorrhagic shock as reduced tissue perfusion resulting from excessive blood loss. Guidelines recommend rapid diagnosis and treatment of bleeding, optimizing oxygen delivery and volume through fluids and blood products. Early coagulopathy should be monitored and treated with plasma, fibrinogen, platelets and tranexamic acid. Definitive surgical or angiographic intervention is important when bleeding is uncontrolled.
Shock - Pathophysiology, Clinical Features & ManagementAnkit Sharma
1. Hemorrhagic shock is the most common cause of shock in surgical or trauma patients and results from blood loss that exceeds 15% of circulating volume.
2. Initial management of hemorrhagic shock involves identifying the source of bleeding, providing immediate resuscitation with fluids and blood products, and controlling hemorrhage.
3. Damage control resuscitation principles are followed, including permissive hypotension to limit blood loss and balanced use of crystalloids, colloids, platelets, and plasma to prevent coagulopathy.
1. Shock is defined as a systemic state of low tissue perfusion that is inadequate for normal cellular respiration. It occurs when there is insufficient delivery of oxygen and glucose to cells, causing cells to switch from aerobic to anaerobic metabolism. If perfusion is not restored, cell death ensues.
2. The main types of shock are hypovolemic, cardiogenic, obstructive, distributive, and endocrine shock. Hypovolemic shock, the most common type, is caused by blood or fluid loss. Cardiogenic shock results from cardiac dysfunction that reduces cardiac output.
3. The goals of shock resuscitation are to increase oxygen delivery, decrease oxygen demand, improve cardiac
Educative power-point presentation for students in paediatrics, paediatric critical care, neonatology, And trainees or fellows in paediatric critical care
Cardiogenic shock is a life-threatening condition caused by the heart's inability to pump enough blood to meet the body's needs, usually due to a severe heart attack damaging the heart muscle. Symptoms include increased respiratory rate, decreased heart rate, decreased urine output, and decreased consciousness. Treatment focuses on oxygenation, increasing systemic vascular resistance through vasopressors like epinephrine and norepinephrine, and improving heart contractility with medications that activate beta-1 receptors. Preventing cardiogenic shock involves maintaining a healthy heart through lifestyle.
Shock is defined as inadequate tissue perfusion resulting from reduced blood flow or oxygen delivery. There are four main types of shock: hypovolemic, cardiogenic, distributive, and obstructive. The management of shock involves treating the underlying cause, restoring circulating volume with intravenous fluids, and providing supportive care such as oxygen supplementation. Goals are to improve oxygen delivery and prevent end organ damage. Early recognition and treatment are important for successful management.
Definition of shock
Initial Assessment of shock – ABC
Types of Shock
Stages of Shock
Physiologic Determinants of Shock
Common Features of Shock
Work-up of shock
General Approach to management of shock
This document defines and discusses the pathophysiology of different types of shock: cardiogenic, obstructive, hypovolemic, and distributive. It notes that shock occurs when there is inadequate perfusion and oxygenation of cells, leading to cellular and organ dysfunction. The key signs of shock include tachycardia, hypotension, altered mental status, and decreased urine output. Early goal-directed resuscitation is important to prevent end organ damage and death, and should focus on airway management, oxygenation, fluid resuscitation, and treating the underlying cause.
1. Shock is defined as a state of low tissue perfusion resulting from inadequate oxygen and glucose delivery to cells. This causes cells to switch from aerobic to anaerobic metabolism, leading to cell death if not corrected.
2. The pathophysiology of shock involves simultaneous cellular, microvascular, and systemic changes including metabolic acidosis, organ ischemia, immune system activation, and sympathetic nervous system response.
3. Shock is classified based on its underlying cause as hypovolemic, cardiogenic, obstructive, distributive, or endocrine. Resuscitation priorities include addressing hypovolaemia with intravenous fluids before considering further treatment.
The document discusses shock pathophysiology and management. It defines shock as inadequate tissue perfusion leading to hypoxia. Oxygen delivery is determined by cardiac output and hemoglobin/oxygen saturation levels. The types of shock are classified as hypodynamic or hyperdynamic based on cardiac output. Treatment involves fluid resuscitation and vasopressors to support perfusion as needed.
The document discusses several common acute complications that can occur during hemodialysis treatments. It notes that hypotension occurs in 25-55% of patients and is the most frequent complication. Other common complications include muscle cramps (5-20% of patients), nausea/vomiting (5-15%), chest pain (2-5%), and back pain (2-5%). The document provides details on the causes, risk factors, prevention, and treatment of these complications, particularly hypotension and muscle cramps. It also discusses less common but potentially life-threatening issues like dialysis disequilibrium syndrome, air embolism, and seizures.
1. The document discusses various markers that can be used to define and assess low cardiac output, including lactate levels, mixed venous oxygen saturation, oxygen delivery and extraction ratio.
2. Treatment for low cardiac output syndrome focuses on improving contractility through the use of inotropic agents like calcium, dobutamine and milrinone, as well as vasodilators to reduce afterload like sodium nitroprusside.
3. The effects of various inotropes are discussed, noting that dopamine has limited benefit and epinephrine does not increase pulmonary or systemic vascular resistance like dopamine. Milrinone provides inotropic and vasodilatory effects with minimal increase in heart rate.
The post operative period begins after surgery and focuses on enabling successful recovery. It aims to reduce mortality, length of stay, and costs through quality care. Patients are monitored in the PACU or SICU by nurses. They assess vitals, consciousness, bleeding, pain/anxiety and more to detect complications and ensure stability for discharge. The goal is safe transfer from intensive recovery phases to continued recovery in step-down units or at home with instructions.
The document outlines a post-operative care plan, including pre-op pelvic floor exercises, drain and catheter care, analgesia medications for immediate post-op and discharge, and follow-up instructions for clip and catheter removal within 10-14 days of surgery.
The document discusses preoperative and postoperative care. It covers preoperative assessment including history taking, physical examination, and risk assessment. Preoperative preparation includes fasting, blood tests, medication administration, and informed consent. Premedication goals are to reduce anxiety, secretions, and nausea/vomiting. Common premeditations include anticholinergics like atropine and scopolamine, benzodiazepines like diazepam and midazolam, and narcotics like pethidine and morphine. Care is taken to minimize risk and ensure patient safety before, during, and after surgery.
1. Total body water content is approximately 60% of body weight in young adult males and 50% in young adult females. It is distributed between intracellular fluid (40% of total body water) and extracellular fluid (20% of total body water), with the extracellular fluid further divided between interstitial fluid and plasma.
2. Intravenous fluid therapy is indicated when oral intake is not possible or in conditions involving significant fluid and electrolyte imbalances. Common intravenous fluids include crystalloids like normal saline and Ringer's lactate, as well as colloids like albumin and hetastarch.
3. Selection of appropriate intravenous fluid depends on the clinical situation and includes factors like maintenance of hydration
The document discusses postoperative care and monitoring of surgical patients. It covers assessing vital signs, pain, mobility and complications in various body systems. Common complications include respiratory issues like atelectasis, cardiovascular problems like hypotension, and gastrointestinal issues like nausea. It provides guidance on monitoring for and managing specific complications, as well as care aspects for different surgical specialties. Regular evaluation of patient progress and problems is emphasized.
The document discusses post-operative care provided in the post-anesthesia care unit (PACU) and surgical intensive care unit (SICU). It outlines the purposes of post-op care which are to enable successful recovery, reduce mortality and length of stay, and provide quality services. Common post-op complications involving respiratory, cardiovascular, renal, and gastrointestinal systems are described along with nursing interventions. Phases of care in the PACU including monitoring, pain management, prevention of complications are covered. Criteria for discharge from the PACU including stable vitals and Aldrete score are also summarized.
The document discusses various common post-operative complications that can occur. It describes how the first post-operative assessment establishes a baseline and identifies any issues from transfer to the ward. Potential early complications within the first 2 days include fever, while issues between days 3-5 can include bronchopneumonia or sepsis. Specific wound complications like seroma, hematoma and dehiscence are also outlined. Other risks reviewed are oliguria, altered sensorium, DVT and potential pulmonary embolism. The document provides details on signs, symptoms and management approaches for each of these post-surgical complications.
This document discusses pain, including definitions of pain, types of pain, factors influencing pain, effects of pain, individual variations in pain response, and pain assessment tools. It also covers postoperative pain management principles like the WHO pain ladder, pharmacological and non-pharmacological interventions for pain control, preemptive analgesia using local anesthetics or other drugs before a painful stimulus to reduce later pain, and techniques like patient-controlled analgesia and epidural analgesia. The goal of pain management is to prevent pain from interfering with recovery through adequate assessment and treatment.
Fluid and electrolytes management in post op patientsDr.Sonal Dixit
This document discusses fluid and electrolyte management in postoperative patients. It begins by explaining how surgery can disrupt normal physiology and fluid balance. It then outlines goals for postoperative fluid therapy and factors to consider when determining fluid needs. Routine intravenous fluid regimens for the first 3 days are presented. The document also addresses specific issues like fluid management in patients with hypertension or diabetes and blood transfusion guidelines.
This document discusses using telemedicine for postoperative care and long-term follow-up of surgical patients. A study was conducted at SGPGIMS in Lucknow, India between 2004-2007 where patients who underwent thyroid or parathyroid surgery were given the option to attend follow-up appointments via telemedicine rather than returning to the hospital. The results found that telemedicine reduced inconvenience for patients, saved them time and money, and allowed for dosage adjustments and cancer monitoring without repeat visits. Over 80% of teleconsultations were for dosage adjustments. Patients reported high satisfaction and an average of 14.5 days of leave saved per patient through the use of telemedicine for postoperative follow-up.
This document discusses postoperative fever, including its definition, pathophysiology, and causes. Fever is a common inflammatory response after surgery due to cytokine release from tissue trauma. Within 24 hours of surgery, 27-58% of patients may develop a fever from non-infectious causes. Infectious causes of postoperative fever include pneumonia, urinary tract infections, wound infections, deep vein thrombosis, and drug reactions. A thorough physical exam and diagnostic tests can help identify the cause, and treatment depends on the underlying condition, such as draining an abscess, treating a urinary tract infection with antibiotics, or providing anticoagulation for deep vein thrombosis.
Coronary artery bypass grafting (CABG) is a surgical procedure that improves blood flow to the heart. During CABG, a healthy blood vessel is grafted to bypass blocked coronary arteries and restore blood flow to the heart muscle. The internal thoracic artery, radial artery, and saphenous vein are common graft conduits. The procedure requires general anesthesia and opening the chest via median sternotomy. Grafts are sewn to the coronary arteries above and below the blockages to reroute blood flow around them. Post-operative care focuses on monitoring for bleeding, arrhythmias, and other complications. Nursing care involves assessing the patient, providing wound care, managing pain, and educating on lifestyle changes and
Dokumen tersebut membahas tentang jenis-jenis pembedahan, kebaikan dan keburukan pembedahan ambulatori, serta peranan perawat dalam pengurusan pra- dan pasca-pembedahan yang meliputi penilaian awal pasien, persediaan pra- dan pasca-operatif, serta kriteria kesesuaian pasien untuk pulang.
Management of post operative bleeding parta7med2101
The document outlines steps for managing post-operative bleeding, including reassuring the patient, taking a thorough history, properly preparing with gloves and good lighting, using suction to clean the area and identify the bleeding source, applying pressure to stop gingival bleeding, and if bleeding continues, achieving hemostasis through local anesthesia and suturing or using a bone pack. It provides references for further information.
This document discusses post-operative fever, its causes, and approach to evaluation and management. It notes that the most common cause of post-op fever within the first 48 hours is atelectasis. Non-infectious causes include drug fever, thromboembolism, and tissue ischemia. Infectious causes may be device-related or not. Evaluation of post-op fever should consider timing of onset and perform targeted testing and imaging to identify potential sources and guide treatment. An individualized approach is important to differentiate between infectious versus inflammatory causes of fever.
Major surgery can lead to complications that are either due to anesthesia or the surgery itself. Complications due to anesthesia include issues from the anesthetic agent like allergic reactions or toxicity. Complications during surgery include problems like hypotension, blood loss, or air embolisms. After surgery, immediate complications involve things like respiratory problems, hemorrhage, infections, or organ-specific issues. Long-term complications include problems like adhesions that can cause intestinal obstructions or abnormal scarring from wounds. In summary, both the anesthesia and surgery involved in major procedures can lead to a variety of potential complications, both immediately after as well as long-term.
1. Shock is defined as inadequate tissue perfusion to meet metabolic demand and can be caused by hypovolemia, cardiac dysfunction, obstruction of blood flow, or inappropriate blood vessel dilation.
2. Clinical signs of shock include tachycardia, abnormal capillary refill time, weak pulses, hypotension, and altered mental status.
3. Management of shock involves optimizing oxygen delivery through fluid resuscitation, antibiotics, vasopressors, ventilation, and treating the underlying cause to increase blood pressure and tissue perfusion.
The document discusses shock in children, defining it as circulatory system failure to supply oxygen and nutrients to meet cellular demands. It covers circulatory physiology, classifications of shock, evaluation, treatment including fluid resuscitation and vasoactive drugs, and specific types of shock such as hypovolemic, cardiogenic, obstructive, and distributive shock. Metabolic issues associated with shock like acid-base and electrolyte abnormalities are also reviewed.
Shock is a clinical condition caused by inadequate tissue perfusion leading to cellular ischemia. The main causes of death in surgical patients are from shock. Shock can be classified as cardiogenic, hypovolemic, distributive, or obstructive. The key features of shock are hypotension, tachycardia, altered mental status, and signs of poor peripheral perfusion. Treatment involves rapid fluid resuscitation to restore perfusion, with blood products as needed. Ongoing fluid needs and use of vasopressors depends on the type and severity of shock. Monitoring includes vital signs, urine output, lactate, and base deficit to guide resuscitation efforts until tissues are fully resuscitated.
This document provides information on shock, including its definition, types, pathophysiology, clinical features, and management. It defines shock as a state of inadequate tissue perfusion and oxygenation that can lead to organ dysfunction and death. The main types of shock discussed are hypovolemic, septic, and cardiogenic shock. For each type, the document outlines their pathophysiology, signs and symptoms, and general management approach. Overall, it serves as an overview of shock for medical students, covering the essential details of definitions, types, effects on organ systems, and clinical distinctions between compensated and decompensated states of shock.
The document discusses the definition, pathophysiology, classification, clinical features, diagnosis, and management of shock in children. Shock is defined as a physiologic state characterized by a reduction in systemic tissue perfusion resulting in decreased oxygen delivery to tissues. The main types of shock are hypovolemic, cardiogenic, obstructive, and distributive shock, and treatment involves identifying the cause, restoring circulating volume and tissue perfusion through fluid resuscitation and vasoactive medications, and treating any underlying conditions.
This document provides an overview of shock, including its classification, pathophysiology, stages, diagnostic studies, and collaborative care. Shock is defined as a syndrome characterized by decreased tissue perfusion and cellular metabolism due to an imbalance in oxygen supply and demand. The main types of shock discussed are cardiogenic, hypovolemic, neurogenic, anaphylactic, and septic shock. The stages of shock progression from initial to refractory are also outlined. Key aspects of shock management include identifying the cause, restoring perfusion through fluid resuscitation and vasoactive drugs if needed, and supporting failing organs.
This document discusses shock, including its definition, pathophysiology, types, stages, and effects on body systems. Shock is defined as a failure of the circulatory system to maintain adequate organ perfusion. The main types are hypovolemic, cardiogenic, and distributive shock. The stages include initial, nonprogressive, progressive, and refractory. Effects include tissue hypoxia, acid-base imbalances, coagulopathies, and end-organ damage. General signs are tachypnea, tachycardia, hypotension, altered mental status, and oliguria. Early goal-directed resuscitation is important to prevent progression to irreversible shock.
Presentation on clinical signs of hypovolemic shock and the best ways to approach stabilizing these patients before sending them on to a referral center with more sophisticated equipment for treating such cases.
This case presentation summarizes the management of a patient presenting with septic shock secondary to gastrointestinal loss and hypoglycemia. The 30-year-old male was referred from a primary hospital with diarrhea, vomiting, and altered mental status. On admission, he was found to be in septic shock with a low blood pressure, fast heart rate, and low blood sugar. He was treated aggressively with IV fluids, antibiotics, vasopressors, and glucose supplementation. Despite initial stabilization, his condition deteriorated with the development of aspiration pneumonia and bacterial meningitis. He was discharged against medical advice before further interventions could be pursued.
Anesthesia for non cardiac surgery in adults with Congenital Heart DiseaseAnkita Patni
This document discusses anaesthetic management considerations for adults with congenital heart disease undergoing non-cardiac surgery. It outlines common congenital heart defects seen in adults and their long-term consequences, including pulmonary hypertension, bleeding/thrombosis risk, heart failure, and dysrhythmias. It provides guidance on preoperative evaluation, intraoperative monitoring tailored to specific defects, management strategies for defects like Fontan circulation, and postoperative care focused on preventing complications in the ICU.
A very narrative discussion over Shock & Haemorrhage, Blood Transfusion, Blood Products which is presented in seminers. A concise guideline of a vast chapter.
This document discusses shock and its pathophysiology. It begins by defining shock as inadequate perfusion leading to inadequate oxygen delivery to tissues. It then covers the stages of shock from the initial insult through compensatory mechanisms failing, leading to end organ damage and potential death. It discusses the different types of shock including cardiogenic, hypovolemic, neurogenic, and septic shock. The document provides details on cardiovascular physiology and the body's compensatory responses to maintain perfusion. It also discusses signs and symptoms of shock along with criteria for diagnosis and treatment approaches.
This document discusses shock and its pathophysiology. It begins by defining shock as inadequate perfusion leading to inadequate oxygen delivery to tissues. It then covers the stages of shock from the initial insult through compensatory mechanisms failing, leading to end organ damage and potential death. It discusses the different types of shock including cardiogenic, hypovolemic, neurogenic, and septic shock. The document provides details on cardiovascular physiology and the body's compensatory responses to maintain perfusion. It also discusses signs and symptoms of shock along with criteria for diagnosis and treatment approaches.
1) The document provides an overview of shock, including common clinical features, key hemodynamic parameters, and types of shock. It also reviews vasopressors commonly used to treat shock.
2) Emergency disorders in critical care are reviewed, including acute inhalational injuries, anaphylaxis, hypertensive emergencies, hyperthermic emergencies, hypothermic emergencies, and toxicology. Management strategies for these conditions are discussed.
3) Case examples are provided to demonstrate assessment and treatment of patients presenting with septic shock, acute liver failure, and altered mental status, and the appropriate next steps in management are outlined.
Shock is defined as inadequate tissue perfusion due to reduced cardiac output, which can lead to organ dysfunction and high mortality if not treated early. Tissue perfusion depends on mean arterial pressure and cardiac output. There are four categories of shock depending on the cause of reduced cardiac output: hypovolemic, cardiogenic, distributive, and obstructive. Early intervention is needed to support physiological compensatory mechanisms and reverse the causes of shock through measures like fluid resuscitation and vasopressor drugs in order to prevent progression to refractory shock.
Shock is defined as inadequate tissue perfusion due to reduced cardiac output, which can lead to organ dysfunction and high mortality if not treated early. Tissue perfusion depends on mean arterial pressure and cardiac output. There are four categories of shock depending on the cause of reduced cardiac output: hypovolemic, cardiogenic, distributive, and obstructive. Early intervention is needed to support physiological compensatory mechanisms and reverse the causes of shock through measures like fluid resuscitation and vasopressor drugs in order to prevent progression to refractory shock.
The document discusses different types of shock including cardiogenic shock, hypovolemic shock, and distributive shock. Cardiogenic shock is defined as inadequate pumping of the heart due to cardiac dysfunction or obstruction. It commonly occurs after myocardial infarction and has a high mortality rate. Hypovolemic shock results from inadequate circulating blood volume due to blood or fluid loss. Both types of shock can lead to organ dysfunction if not treated promptly with fluid resuscitation, vasopressors, and other supportive measures. The document provides details on the pathophysiology, clinical manifestations, diagnostic evaluation, and management of cardiogenic and hypovolemic shock.
Shock is defined as inadequate organ perfusion and tissue oxygenation. It can be caused by hypovolaemia from blood loss, cardiac issues, or neurogenic factors. The body activates compensatory mechanisms through the cardiovascular, renal, respiratory, and cerebral systems but these fail over time without treatment. Signs of shock include decreased consciousness, fast heart rate, pale skin, and low urine output. Treatment involves fluid resuscitation, controlling bleeding, and monitoring the patient's color, breathing, pulse, and consciousness. Without adequate treatment, shock leads to multiple organ failure and death.
This document provides an overview of shock, including its definition, pathophysiology, classification, signs and symptoms, initial management, and specific types such as hypovolemic, septic, cardiogenic, and obstructive shock. It defines shock as inadequate tissue perfusion and oxygen delivery, discusses the body's compensatory mechanisms and their failure in severe shock. It classifies shock into hypovolemic, cardiogenic, distributive, and obstructive types and provides details on managing each type, including damage control resuscitation for hemorrhagic shock and use of vasopressors for neurogenic shock. Key goals in shock management are outlined as well as factors like lactate and base deficit that can guide res
2. Applied physiology
Needs good understanding of whole body
physiology as well
Not limited to one organ system!!!
What would be the major issues in such a
patient?
5. Systemic response to surgery
Secretion of pituitary hormones plus activation of
the sympathetic nervous system
Catabolism
Breakdown of skeletal muscle and fat
Insulin resistance and hyperglycaemia
Retention of salt and water
7. Systemic response to surgery
SIRS (Systemic inflammatory response
syndrome) (at least 2 of the following criteria):
Temperature > 38 0C or < 36 0C
HR > 90
RR > 20
WBC count < 4 or > 10 or > 10% immature neutrophils
SIRS may lead to organ injury or failure, often
multiple
8. Haemodynamic response
Hypovolemia due to blood loss or fluid loss
Post-op fluid and water retention, independent of
intraoperative loss
ADH
Aldosterone
Immune response: Increased Cytokine release,
complement activation- may lead to SIRS
Impaired (exhausted) response may predispose to
infections
9. Effects of anaesthetics
Opioids
Respiratory depression
Suppress hypothalamic and pituitary hormone release esp. ACTH
Suppress the hyperglycaemic response
Non-osmotic release of ADH (SIADH)
Decrease bowel motility - ileus
Benzodiazepines
Inhibit cortisol production
Etomidate
Suppresses cortisol and aldosterone production – increases mortality
Clonidine - Inhibits stress response
10. Regional anaesthesia
Epidural or paravertebral blocks
Blocks both pain and efferent autonomic output in pelvic and LL
surgeries, less effective for thoracic and upper abdominal
surgeries
Can cause urinary retention (esp. intrathecal morphine)
11. Case
Mr X, 39/M post-op in Critical care (Previously
well)
Emergency laparotomy for peritonitis
Previous urgent laparotomy 1 week ago for
diverticular perforation
Pre-op: GCS 14, HR 112, BP 90/58 mm Hg,
SpO2 on room air 89%, Urine output 15-25
mL/hr
12. Post-operative physiology
Impact of derangements depend on:
Type of surgery – Elective Vs Emergency
General health pre-op
Co-morbidities
Organ dysfunction(s) present (acute and chronic)
Duration of surgery
Anaesthetic management
Post-anaesthetic care
13. Surgery-specific
Operative site- e.g.; H&N or airway surgery,
abdominal surgery etc.
Bleeding or discharge from drains or wound(s)
'Health' of the stoma
14. General Considerations
Pain management
PONV
Temperature management
Fluid management- volume status determination
Organ system support- Respiratory and Cardiovascular, Renal
Nutritional considerations
Preventing complications of immobility
Housekeeping
15. Pre-existing conditions
May require specific management eg; CCF,
COPD, CKD
May need careful balancing of goals eg: Fluid
management in the patient with CCF
16. Organ systems
Neurologic
Level of consciousness
Cardiovascular
CR (if not hypothermic)
Respiratory
Rate, FiO2, Pattern, SpO2
Renal
Urine output- accept a total output of > 500
mL over 24 hrs
18. Pain
What is the problem with pain?
Complex entity made up of sensory, affective,
motivational and cognitive dimensions
Unpleasant for the patient
Sympathetic responses- HR, BP, increased O2
demand
Site-specific: Respiratory compromise
Inability to mobilise/physio
19. Pain
Neuroendocrine effects- the SIADH
Non-osmotic signal to retain fluid
Manifest as post-op Hyponatremia and/or oliguria
despite clinically normal cardiac output and volume
status
20. Pain management
Prevention is better than cure
Multimodal analgesia
IV, Regional and Local techniques
Side-effect profile very important, eg;
respiratory depression with opioids
21. Temperature
Why is 'normal' temperature important?
Causes of hypothermia in post-op patients?
Problems with hypothermia:
Shivering
Metabolic acidosis
Cardiovascular issues- arrhythmias, increased O2
demand, cardiovascular depression etc.
↓ drug metabolism, ↓ platelet function, drowsiness
22. Cardiovascular issues
• Low BP
• HTN
• Arrhythmias
• Cardiac ischaemia
• More common with pre-existing cardiac or
respiratory dysfunction
23. Cardiovascular issues
Cardiovascular 'signs' of low volume status
How reliable is BP as an index of volume in the
post-op period?
What is the most important cause of HTN in this
scenario?
Pain
Anxiety, drug withdrawal, urinary retention
What are the causes of Hypotension?
25. Management of Hypotension
Determine the Volume status
We have been struggling for over 50 yrs to do so!!!!
History and physical examination essential
Previous or ongoing fluid losses and intake (I/O charts)
3rd space losses?
Sluggish CR
Postural hypotension
Persistently poor urine output
Signs of heart failure
Patients for elective surgery are unlikely to be ‘fluid-deficient’ peri-operatively
26. Options to manage Hypotension
What are we trying to achieve????
'Normal' perfusion- a cardiac output that is
'sufficient' to meet body needs without incurring
the risk of complications
CO = Stroke volume x HR
Stroke volume depends on Preload, Afterload
and Contractility
HR and rhythm important
27. Options to manage Hypotension
How important is it to 'normalize' the patient's
vitals?
Is the 'low' BP compromising the patient, or is it
likely to compromise him/her?
Options- optimise preload (CVP or JVP gives a
rough idea- please do not chase numbers)
Avoid medications that could compromise
contractility eg; anti-hypertensives, anti-CCF
28. Role of the 'Fluid Bolus'
Estimation of the volume status extremely
difficult, even in intensive care
Estimate pre- and intra-op fluid losses and
replacement
Duration of pre-op pathology
Intake pre-op
Anaesthetic charts for intra-op Mx
Normal fluid requirements 30 mL/kg/day
29. Role of the 'Fluid Bolus'
Patient warm, CR < 2
s, no organ system
derangement obvious
SBP 96, MAP 65
U/O 20 mL in last
hour
Does this patient
need a fluid bolus?
30. Fluid bolus
Ensure fluid bolus is targeted at physiologic need, rather
than to (ad)dress numbers!!!!
Low volumes of fluid (250 mL or 500 mL)- constantly re-
assess for response before going on to next bolus
Have a ‘stop’ limit in your mind!
Keep the clinical situation in mind-are we actually dealing
with a low CO?
Is tissue perfusion adequate?
Is the patient bleeding?
31. Complications of fluid overload
Pulmonary congestion
APO
Pleural effusions
Hypoxia
Worsen heart failure
Worsen bowel perfusion and impair anastomotic healing
Ascites
Worsen renal perfusion
Hyperchloremic metabolic acidosis
Dilutional throbocytopenia
32. Hypotension-vasoactive agents
Leaky capillaries due to SIRS
Myocardial dysfunction
Problems with excessive fluid ‘resusc’
Choice of agent depends on principal reason for
hypotension: Cardiac dysfunction (Inotropic
agents) Vs. Vasoplegia (Vasopressors)
34. Hypoxia
SpO2 < 90% on room air (Aim > 90-92%)
What are the important causes of hypoxia?
Is PaO2 more important than the SpO2?
• Pain causing respiratory compromise-hypoventilation,
impaired sputum clearance
• Fluid overload
• Collapse (Atelectasis)
• Consolidation
• Aspiration
• PE
• Surgery-specific – Pneumothorax post-thoracic surgery or
post-CVC insertion
35. Management of Hypoxia
O2 Supplementation
Improve V/Q mismatch
SOOB, Physiotherapy
Diuresis
Positioning
Specific cause –e.g. Antibiotics
36. Mx of Hypoxia
Mechanical ventilation or Non-invasive
Ventilation if:
↑ WOB
SpO2 < 90% on high FiO2 (> 0.5)
Progressive or severe respiratory acidosis, or
inability to compensate for metabolic acidosis
Severe Pain causing impairment of respiration or of
cough
37. Volume status and renal function
Post-op tendency to fluid retention due to SIADH (non-osmotic
release of ADH)
Sympathetic response contributory
Hyponatremia very common
'Leaky' capillaries- loss of intravascular fluid into interstitial spaces
Urine output decreases not a reliable sign of hypovolemia
Do not administer fluid boluses to improve urine output if CO
clinically adequate!!!
38. Oliguria
Pre-existing cardiovasc or renal issues
Causes:
Intravascular volume depletion
Hypotension
Low Cardiac output
Nephrotoxic agents-IV contrast
Direct injury to ureters
Obstruction at level of bladder (? blocked IDC)
Heard of the abdominal compartment syndrome???
39. Renal Function
Anuria always a cause for concern
Most common causes for kidney compromise are- hypotension
and hypoxia
Intravascular volume depletion
Excessive use of chloride-rich IV fluids (NS, Gelofusine)
Suspect surgical issues- eg: have the ureters been ligated (Pelvic
surgery)- very rare cause
Mild rhabdomyolysis due to prolonged positioning intra-op
Generally, re-establishing adequate perfusion and avoiding
nephrotoxic agents resolves the issue.
Dialysis may be needed for usual indications
40. Don't forget the gut!!!
Bowel dysmotility- paralytic ileus
Type of surgery
Opioids
Nutritional issues
41. Refeeding syndrome
Severe hypophosphatemia (respiratory- and
cardiac failure, shock, rhabdomyolysis, seizures
and delirium) due to insulin release after period
of fasting. Associated with hypokalemia and
hypomagnesemia.
Malnourished patients, alcoholics, ongoing
electrolyte losses are predisposed
Monitoring is critical
42. Glucose control
Insulin resistance and catabolic state with surge of
counter-regulatory hormones
Very important to maintain euglycaemia (BSL 7-
10) esp after major surgery
Adverse effects of Hyperglycaemia: Wound
infection, osmotic diuresis, dyselectrolytemias
43. Anaemia and blood loss
Causes:
• Surgical bleed
• 'Dilutional'
• Pre-existing anaemia
Contribution of coagulopathy
Why are we concerned?????
44. 'Management' of anaemia
Correct the cause- surgical bleed to be corrected (surgical Vs. radiologic Vs.
Endoscopic)
Correct coagulopathy- what are the post-op factors that can worsen
coagulopathy???
Considerations: Site, amount, and haemodynamic significance, and patient's
tolerance
We are trying to improve/maintain oxygen delivery
RBC transfusions usually not required
Role of prophylactic PPI to prevent stress ulceration
45. Thromboembolism
Surgery and anaesthesia foster a hypercoaguable
state
High risk of DVT post-op
Methods to protect and prevent
Sometimes problematic if concurrent bleeding
issues
47. Post-op Fever
Does fever always mean an infection???
What are the non-infectious causes of fever?
DVT/PE
Indwelling devices e.g. CVC
Medications (drug fever) or Drug withdrawal
Stroke or intracranial bleed
Seizures
SIRS
Transfusion reactions
48. Delirium
• Very common
• Causes:
• Predisposing factors (age, dementia, sensory deprivation)
• Pain
• Direct neurologic insult
• Organ dysfunction
• Sepsis (think surgical sepsis)
• Drugs eg; opiates
• Urinary retention (esp. with neuraxial blocks)
• Never forget hypoxia, hypercarbia or low BSLs
49. Delirium treatment
Prevention always best
Early recognition
Re-orientation and reassurance
Family presence
Nocte antipsychotics
Chemical – haloperidol, olanzapine etc.
50. Metabolic issues
• Metabolic acidosis very common
• Hypothermia and peripheral vasoconstriction
• Hyperchloremic acidosis
• Accentuated by lack of ability to self-correct in
an anaesthetised patient
• Concern if reflects persistent low cardiac output
state (Raised lactate)
51. Site-specific problems
Thoracic surgery
Pain with respiratory
impairment
Pneumothorax
Haemorrhage
Abdominal surgery
Pain with respiratory
impairment
Post-op ileus
Abdominal compartment
syndrome
Bleeding
53. Warning signs
What are the danger signs of organ
dysfunction???
Trends are more important than single 'snapshot'
values
Exceptions are- airway obstruction, ↓LOC, Shock,
Severe hypoxia or cyanosis, respiratory distress
or anuria