Download SHO Intro

SHO
Intro
Ward round Cardiac Surgery
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Well or Unwell ?
BP
Pulse
Temp
Weight
Wounds
Lines and drains
Drug chart
CXR
ECG
Bloods FBC, U & E, INR, CKMB, levels
Ward round Thoracic Surgery
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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)
Drug Charts
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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
Cardiac Drug Charts
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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
Thoracic Drug charts
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Analgesia
? Antibiotics
DVT prophylaxis (beware epidurals)
Nebs
– Ventolin Neb 5mg qds
– Atrovent Neb 500 micro g qds
– Saline Neb 5ml all times
Analgesia
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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
Increased Weight
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Diuretics
Frumil (unless creat raised)
Watch K+ with frumil
Watch frumil and ACEI or spironolactone
interactions
• Catch Renal failure, Chronic tamponade
Atrial fibrillation
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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
Urine output
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What operation ?
When was op ?
What is BP ?
What is creatinine?
Well or unwell ?
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If BP not low need volume and or diuretics
If BP low treat BP
If creat high and rising need urinary catheter
Catch Tamponade
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
Blood Pressure
• High
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Ca2+
Beta
ACEI
Alpha
Angiotensin II
• Low
– Intravascular depletion
– Tamponade
– MI or valve failure
• Well or unwell ?
CXRs, Bloods, ECGs
• What operation ?
• Well or unwell ?
• Compare with previous
• Beware changes in Hb not low Hbs
INRs
• Why the warfarin ?
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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
SOB Patient
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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
Consultant Preferences
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Iron sulphate
Radial artery amlodipine, ISMN
AF
CABG under JACC ISMN for 3/7
Dosages of aspirin
Mediastinal drainage
Heparin / fragmin preferences
Remember
As soon as you tell your Reg it is their problem !
So just ask!