SHO Intro - PowerPoint PPT Presentation

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SHO Intro

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  1. SHOIntro

  2. Ward round Cardiac Surgery • Well or Unwell ? • BP • Pulse • Temp • Weight • Wounds • Lines and drains • Drug chart • CXR • ECG • Bloods FBC, U & E, INR, CKMB, levels

  3. Ward round Thoracic Surgery • Well or Unwell ? • Temp, Pulse, BP, sputum, cough • Wounds • Watch AF • Drug chart • CXR every day for pneumonectomy • Bloods FBC, U & E • Epidural as soon as oral meds control pain • Drains (suspicion of air leak, or drain > 200mL/24hr period leave in)

  4. Drug Charts • Analgesia • DVT prophylaxis • Beware dual prescribing • Paracetamol regular and codydramol prn • If more than 1 chart then write 1 of 2 or 3 on it • Don’t need heparin if INR therapeutic • Simvastatin and clopidogrel

  5. Cardiac Drug Charts • Analgesia • ? Antibiotics • DVT prophylaxis • Aspirin +/- clopidogrel • Anti lipid • ACEI if poor LV ? • Something for radial artery ? • Warfarin needed ? • Diuretic for weight ? • BP tablet ? • Nebs if chesty • Ventolin Neb 5mg qds • Atrovent Neb 500 micro g qds • Saline Neb 5ml all times

  6. Thoracic Drug charts • Analgesia • ? Antibiotics • DVT prophylaxis (beware epidurals) • Nebs • Ventolin Neb 5mg qds • Atrovent Neb 500 micro g qds • Saline Neb 5ml all times

  7. Analgesia • Well or Unwell ? • What is the cause ? • Drain site, can drain come out ? • Local injection around or into drain • Paracetamol, DF118, Codydramol, tramadol • Don’t combine Codydramol, tramadol • No pethedine, morphine, MST, OR voltarol

  8. Increased Weight • Diuretics • Frumil (unless creat raised) • Watch K+ with frumil • Watch frumil and ACEI or spironolactone interactions • Catch Renal failure, Chronic tamponade

  9. Atrial fibrillation • Get ECG, K+, O2 sats • Well or unwell ? • K<4.5 treat • Sats <95% think • Digoxin, Amiodarone, Sotalol • Think why eg OG leak, sputum retention

  10. Urine output • What operation ? • When was op ? • What is BP ? • What is creatinine? • Well or unwell ? • If BP not low need volume and or diuretics • If BP low treat BP • If creat high and rising need urinary catheter • Catch Tamponade

  11. Infections & Temperatures • If in doubt culture wounds, urine, sputum and blood • Well or unwell ? • Unless culture report ask registrars • Beware Mr Fabri, Pullan, or Page patients

  12. Blood Pressure • High • Ca2+ • Beta • ACEI • Alpha • Angiotensin II • Low • Intravascular depletion • Tamponade • MI or valve failure • Well or unwell ?

  13. CXRs, Bloods, ECGs • What operation ? • Well or unwell ? • Compare with previous • Beware changes in Hb not low Hbs

  14. INRs • Why the warfarin ? • AF INR~2-2.5 • Mitral repair INR~2-2.5 • Endarterectomy INR~2-2.5 • Tissue valve INR~2-2.5 • Mechanical valve (aortic 2.5 to 3.0, mitral 3 to 3.5) • ASD INR~2-2.5 • What dose on pre operatively • Beware little granny and RT heart failure (ie MVRs) • Catch the INR that jumps suddenly;y

  15. SOB Patient • Well or unwell ? • CXR, ECG, examine • Sats on what O2 • If unwell ABG on what O2 • Warm or cold • Infection, Atelectasis, sputum plug, pulmonary oedema, MI, PE

  16. Consultant Preferences • Iron sulphate • Radial artery amlodipine, ISMN • AF • CABG under JACC ISMN for 3/7 • Dosages of aspirin • Mediastinal drainage • Heparin / fragmin preferences

  17. Remember As soon as you tell your Reg it is their problem ! So just ask!