SURGERY - POSTOPERATIVE COMPLICATIONS + FLUIDS / NUTRITION
YEAR 3 | PAGE 29F - RECOGNIZE DETERIORATION + SUPPORT RECOVERY
C. POSTOPERATIVE DETERIORATION - THINK BY SYNDROME, NOT BY MNEMONIC
| Presentation | First-pass reasoning | High-yield causes / decisions |
|---|---|---|
| Tachycardia / hypotension | Is this hemorrhage, hypovolemia, sepsis, cardiopulmonary stress or pain? | Reassess perfusion, bleeding, medications, drains and source; stabilize while defining the cause. |
| Hypoxemia / dyspnea | Airway/ventilation problem, aspiration/pneumonia, atelectatic change, PE, pulmonary edema, pneumothorax? | Use severity + bedside findings to choose oxygen/ventilatory support and targeted imaging/testing. |
| Fever / infection concern | Localizing symptoms/signs and host/procedure risk matter more than the postoperative day number. | Consider wound/organ-space infection, pneumonia, urinary/device infection, line infection and noninfectious causes. |
| Oliguria / AKI | Is renal perfusion low, the urinary tract obstructed, or intrinsic injury developing? | Check volume/perfusion context, medications, catheter patency and renal labs; avoid reflex fluid without reassessment. |
| Nausea / distention / no bowel function | Expected postoperative ileus vs medication/electrolyte effect vs mechanical obstruction or complication? | Review operation, exam, bowel pattern and imaging need; recognize peritonitis, ischemia or leak as escalation signals. |
| Wound / drain abnormality | Hematoma, seroma, dehiscence, SSI, abscess, fistula or anastomotic leak? | Look for systemic toxicity and source-control need; antibiotics alone do not substitute for drainage/debridement when indicated. |
| Mental-status change | Medication, hypoxemia, infection, metabolic disturbance, withdrawal, stroke or delirium? | Correct reversible threats first and do not attribute acute change to "just postoperative" status. |
D. FLUIDS, ELECTROLYTES + NUTRITION - THREE DIFFERENT JOBS
| Fluids / electrolytes | Nutrition |
|---|---|
| Resuscitation: restore perfusion in shock or major volume loss; reassess after each intervention rather than giving fluid by habit. | Use the gut when feasible: oral/enteral nutrition usually preserves gut function and should be distinguished from parenteral nutrition. |
| Maintenance: replace normal daily water/electrolyte needs when oral intake is inadequate. | Recognize high-risk states: malnutrition, prolonged poor intake, major catabolic illness, GI discontinuity/obstruction and refeeding risk. |
| Replacement: match ongoing losses from vomiting, NG suction, drains, fistula, diarrhea or high-output ostomy. | Monitor: tolerance, glucose, electrolytes, fluid balance and complications of access/feeding route. |
| Recheck: I/O, weight, exam, urine output, renal function, sodium/potassium/magnesium/phosphate and acid-base context. | Shelf logic: choose the route and timing that fit GI function, aspiration risk and the patient's operative course. |
D. FLUIDS, ELECTROLYTES + NUTRITION - THREE DIFFERENT JOBS
Direct video repair Postoperative Care - Surgery | Lecturio Perioperative Care: Fluids and Electrolytes - Surgery | Lecturio 2026/27 clerkship-expanded edition - verify school and official exam updates before testing