Professor’s Pearls: Postoperative Care
1) A 65-year-old male underwent a left colectomy 5 days ago for colon cancer. Hi preoperative cardiac evaluation prior to surgery was unremarkable. On the morning of POD #5 he presents with sudden shortness of breath while getting out of bed.
VS: T = 99.8, P = 125, R = 26, BP = 130/80
Lung examination: clear bilaterally
ABG pH = 7.48, Pco2 = 30, Pao2 = 84 on room air.
What is your differential dx and what measures would you undertake for dx and therapy?
2) A 70-year-old male with a past medical hx of benign prostatic hypertrophy is status-post lysis of adhesions for a small bowel obstruction. Now, on POD #4, he has a new complaint of lower abdominal pain. He also has had problems sleeping, but the multiple Benadryl PRN he’s received for the past 3 nights have helped. You are called to the floor because he has had no urine output for the past 16 hours.
VS: T = 98.8, P = 92, R = 16, BP = 150/84
Physical examination reveals only suprapubic tenderness.
Stat CBC and BMP are within normal limits except a creatinine of 1.5 (baseline 1.0).
3) A 24-year-old male is 4 days from a gunshot wound to the abdomen with multiple small bowel perforations. He has been persistently febrile since surgery. Breath sounds are diminished at both bases. You are called to see his midline incision because the nurse has spotted material that she believes to be feculent drainage from the superior part of the midline incision.
What is the differential dx? What are your initial diagnostic and therapeutic measures?
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
