Okay. Post-op scenario. Some of the trauma
scenario, I’m just putting one slide of
post-op. Now here I got a AAA, but you can
supplement that with total colectomy, total
hip replacement, any big operation. Take anything.
Essentially, the patient is disoriented and
confused. That's the temperature, heart rate
and blood pressure. So, classical post-op
scenario. Possible causes of confusion in
this patient, why is this patient confused?
Sepsis, I wouldn't say septic shock.
What makes you say septic shock?
Sepsis, okay. Anything else?
Hypoglycemia. Anything else?
Hypoxia, very good. And something, anything
else coming up in the history? Alcohol and
smoking, so nicotine withdrawal or alcohol
withdrawal. Hypoxia, hypoglycaemia, infection,
sepsis, urinary tract infection, lower respiratory
tract infection, then alcohol, nicotine withdrawal,
acute psychosis, acute confusional state,
always make sure, elderly patient, if you’re
asked in the exam, think about acute confusional
Now this one. In your exam, you'll be surprised
how simple some of the questions could be.
Simple bed test markers. What can you do?
What do you really do when you see a patient?
You do an oxygen saturation. Do the BM stick,
get the capillary blood glucose. You do the
urine dip stick, send it for culture. ABG.
Chest x-ray. Septic screen. So this is that
order. So if at all the question says,
what is the
next most appropriate thing to do? You have
to work around this, you need to make sure
that you got that sort of order. Don’t jump
into septic screen, ABG. Make sure that if
you have an option of answering that, go for
that. Oxygen saturation, sorry, yeah.
Temperature besides sepsis, what is the
likely cause? Just urine? Where?
Lungs, quite possibly. Lungs.
Which one? Wound? Probably not in the
first twenty four hours, isn't it? Infection
of chest or sepsis from the chest, urinary
tract, line infection. Peritoneum would be
the last option.
Okay. Post operative thing, what is the commonest
cause of pyrexia postoperatively in our patients
normally? Non-inflammatory response? Or little
bit of atelectasis. That's the commonest one
and a little bit of UTI. These are the commonest
things. Always go for the basic tests in your
exam. Okay. Slightly different scenario.