🔥Postoperative Fever in days

#Postoperative complications
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💢After Operation In each Day Ask about

▪︎When regain Consciousness
▪︎When start oral intake
▪︎When pass Fecess/Flatus
▪︎Urine Output
▪︎Movement
▪︎Nausea & Vomiting
▪︎Cough/Sputum
▪︎Dyspnea/Chest pain
▪︎Surgical Site pain
▪︎Leg Pain
▪︎Bleeding & Wound Discharge
▪︎Fever
▪︎Drains & Catheters (Amount/Color/Tenderness)
▪︎Drugs And treatment Received



#Postoperative complications
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💢Hemorrhoids (piles)
are swollen veins in The anus and lower rectum, similar to varicose veins. Hemorrhoids can develop inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids).

💢Hemorrhoids can develop from increased pressure in the lower rectum due to:

▪︎Straining during bowel movements
▪︎Sitting for long periods of time
▪︎chronic diarrhea or
constipation
▪︎Obesity
▪︎pregnancy
▪︎Eating a low-fiber diet
▪︎Regular heavy lifting

💢Most important Symptom
▪︎Blood After Defecation

#Hemorrhoids (piles)
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💢Rectal Bleeding

🔹History
▪︎Has the patient ever passed any blood in the stool?

▪︎Was it bright or dark?

▪︎How much?

▪︎Was it mixed in with or on the surface of the stool, or did it only appear after the stool had been passed?


🔹All rectal bleeding must be taken seriously and investigated with sigmoidoscopy


🔹The commonest cause of rectal bleeding is piles (Hemorrhoids)


🔹Patients with rectal cancer usually have multiple symptoms. One of the commonest is rectal bleeding, usually a small amount of dark-red blood streaked on the stool


#Rectal Bleeding
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Macleod's Clinical Examination15th Edition 2024
https://t.me/M_Information11

❇️Examination of cannula

▪︎Size (Color)

▪︎Site ➡️ Correctly adjusted in the non dominant hand + away from joints

▪︎signs of thrombophlebitis ➡️ tenderness / erythema / cord like vessel / painful on touch

▪︎connected (to fluid,blood,Drugs) or not ?

▪︎The Dressing clean or not

▪︎the more distal, the better for the patient (risk of thrombophlebitis)

▪︎Away from the great vessels and nerves.


❇️Types of Cannula

▪︎Orange /Gray ➡️ Truma & Major surgery


▪︎Green ➡️ Irritant Drugs & Contrast


▪︎Pink (Most Common) ➡️ IV fluids / AB / Analgesics / Blood


▪︎Blue / Yellow / Violet ➡️ Small & fragile Veins in children /Neonates / Elderly

#Examination
#Surgery_rotation
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❇️Glasgow coma scale

▪︎Severe, GCS < 8–9
▪︎Moderate, GCS 8 or 9–12
▪︎Mild, GCS ≥ 13.

❇️Truma Basics

💢History of trauma

1. Cognitive function: ask who they are, where they live and their occupation.

2. History of the accident: ask the patient what they remember of the accident, and useful if they can describe what happened.


•Type of the Accident

🔹Gunshot:

▪︎Type of machine: low velocity (pistol), high velocity (gun)

▪︎Number of bullets

▪︎Distance from shooter

▪︎Site of inlet and outlet


🔹Road traffic accident:

▪︎Was he the walker (on the street, sidewalk),

▪︎driver, passenger (front or back seats)

▪︎protection (seat belts, airbags)

▪︎Others in accident: injured, dead.

▪︎Type of car and its speed (low or high velocity)

▪︎Damage to the vehicle: collision, rolling


🔹Fall from a height:

▪︎Height of fall

▪︎Did the patient hit anything on his way?

▪︎What position was the body at time of impact?


3. Walking after accident: to exclude pelvic and lower limb injuries.

4. Associated symptoms: Loss of consciousness, bleeding, vomiting, urination, cough, dyspnea .

5. Transportation: car, ambulance

6. The distance of the hospital

7. What resuscitation and procedures done? What organs was damaged.

#Surgery_rotation
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💢A Airway

🔹airway may be compromised due to:

▪︎Blood or swelling in the airway

▪︎Vomit or secretions

▪︎Reduced consciousness


🔹Clinical assessment

▪︎Can the patient talk? 

•Yes ➡️ Patent Airway
•No ➡️ Check Airway 👇

1) Look for signs of airway compromise:
•cyanosis
•see-saw breathing
•use of accessory muscles
•diminished breath sounds
•added sounds (Stridor)

2) Open the mouth and inspect: look for anything obstructing the airway such as secretions or a foreign object

3) Interventions

▪︎Head-tilt chin-lift manoeuvre
•If No Spine Injury
•Push head to the back
•Pull chin Downward

▪︎Jaw thrust Maneuver
•If there is Spine Injury

▪︎Oropharyngeal Tube
▪︎Nasopharyngeal Tube

#Surgery_rotation
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💢B Breathing

▪︎Check the patient’s respiratory rate
▪︎Check the patient’s oxygen saturations

▪︎Look for signs of 
•cyanosis
•respiratory distress
•use of accessory muscles
•abnormal breathing patterns

▪︎Assess for equal chest expansion with respiration and for any obvious chest wall trauma.

▪︎Palpate the position of the patient’s trachea

▪︎Assess for any chest wall tenderness

▪︎Auscultate both lungs for
•good air entry throughout the chest
•added sounds such as crackles and wheeze

💢C Circulation

▪︎Check the patient’s heart rate & blood pressure

▪︎Assess temperature:
•the hands should be symmetrically warm, indicating adequate perfusion.

•Cool hands indicate poor peripheral perfusion (e.g. hypovolaemic shock).

•Pallor or mottled skin: commonly associated with hypovolaemic shock (e.g. haemorrhage)

▪︎Measure capillary refill time (CRT):
•should return to its normal colour in less than two seconds

▪︎Assess the patient’s radial and brachial pulse to assess rate, rhythm, volume and character

▪︎Auscultate the patient’s precordium to assess heart sounds, listening for evidence of murmurs.

#Surgery_rotation
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