Postoperative Protocols At Harborucla

Postoperative Note

This should be written by the junior resident accompanying the patient from the operating room or the junior resident on call.

It should include:

Preoperative diagnosis Postoperative diagnosis

Operation performed, including the number, type and positions of all coronary bypass grafts; the size, type and position of any graft or prosthetic material The operative team The type of anesthesia A list of all lines, catheters and tubes The operative findings

A list of all IV drips and their present infusion rates

Any intraoperative or immediate postoperative complications

General Principles for Initial Care on Arrival to 3W CTU

Vital signs

Record all vital signs immediately on arrival.

Monitoring lines

Detach and reattach to the 3W CTU monitors, one line at a time. Never disconnect and change all lines simultaneously.

Stat labs

Chem-7, CBC with platelet count, PT, PTT, Chest XR, EKG.

Chest tube drainage

Record the chest tube drainage in the Pleur-Evac on arrival to the 3WCTU.


Patients returning from the operating room on a ventilator with an endotra-cheal tube in place should have ventilator settings determined jointly with the anesthetist caring for the patient. The appropriate FIO2, tidal volume calculated on the basis of 10-15cc/kg and ventilatory rate should be determined at this time. Changes in these settings are made by the surgical resident based upon clinical and laboratory findings. It is important to consult the appropriate respiratory therapist caring for any patient when any ventilatory changes are made. This is mandatory since these individuals are highly skilled in artificial ventilation techniques and will help prevent errors in management. Patients on ventilators are at

high risk of inappropriate ventilation and therefore clinical examinations should be performed frequently. The resident must assess the appropriate rise and fall of the individual patient's chest, as well as auscultate both lung fields to ensure ventilation bilaterally. Examination of the position of the endotracheal tube both clinically examination and on the initial postoperative chest x-ray is mandatory. In addition, the surgical house officer is expected to secure the endotracheal tube. Arterial blood gas determination should be performed whenever any question exists about the ventilatory status. However, blood gas determination should not delay making a critical decision in one's management of an individual patient. If one suspects that either ventilation or oxygenation is inappropriate, maneuvers should be taken to adjust the situation prior to obtaining the actual blood gas result. Blood gas determinations are expensive, and should only be ordered when absolutely indicated.

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