Podcast
Questions and Answers
What should be checked regularly in the first 24 hours after surgery?
What should be checked regularly in the first 24 hours after surgery?
What should be done if bleeding is more than expected?
What should be done if bleeding is more than expected?
Why might a patient need to be taken back to the operating theatre?
Why might a patient need to be taken back to the operating theatre?
What treatment is indicated if the haemoglobin concentration is less than 8 g/dL?
What treatment is indicated if the haemoglobin concentration is less than 8 g/dL?
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What is the minimum acceptable platelet count?
What is the minimum acceptable platelet count?
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What is the consequence of minor bleeding in an airway?
What is the consequence of minor bleeding in an airway?
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What is a common symptom of postoperative deep vein thrombosis?
What is a common symptom of postoperative deep vein thrombosis?
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What is the significance of Homans’ sign in diagnosing DVT?
What is the significance of Homans’ sign in diagnosing DVT?
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What imaging modality is used to assess flow and detect thromboses?
What imaging modality is used to assess flow and detect thromboses?
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What is the initial treatment for a significant DVT that extends above the knee?
What is the initial treatment for a significant DVT that extends above the knee?
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What is the purpose of a DVT prophylaxis protocol?
What is the purpose of a DVT prophylaxis protocol?
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Study Notes
Postoperative Bleeding Management
- Regularly check patient's blood pressure, pulse, urine output, dressings, and drains in the first 24 hours after surgery.
- Apply pressure to the bleeding site and send blood samples for blood count, coagulation profile, and crossmatch if bleeding exceeds expected levels for the procedure.
- Initiate fluid and blood resuscitation.
Diagnostic Measures
- Arrange for ultrasound or CT scan to determine the size and extent of the hematoma.
Interventional Measures
- Consider radiological embolisation of bleeding vessels.
- Take the patient back to the operating theatre for immediate control of bleeding if necessary.
Resuscitation and Blood Product Administration
- Continue oxygenation and fluid resuscitation in patients with postoperative bleeding.
- Administer blood or blood products if haemoglobin concentration is less than 8 g/dL.
- Administer fresh frozen plasma, cryoprecipitate, and fibrinogen concentrates if serum fibrinogen levels are below 1 g/L or prothrombin time (PT) and activated partial thromboplastin time (APTT) are greater than 1.5 times normal levels.
- Maintain platelet count above 75 × 109/L.
Important Considerations
- Minor bleeding in an airway can have catastrophic consequences.
Presenting Symptoms of Postoperative DVT
- Patients may present with calf pain, swelling, warmth, redness, and engorged veins
- Most patients will not show any physical signs
Diagnosis of DVT
- Palpation may reveal tender muscle and a positive Homans' sign (calf pain on dorsiflexion of the foot)
- However, Homans' sign is neither sensitive nor specific
- Venography or duplex Doppler ultrasound is used to assess flow and detect thromboses
Treatment of DVT
- Significant DVT (above the knee) requires treatment with intravenous heparin initially
- Followed by longer-term warfarin treatment
- Large DVT may require additional treatment
DVT Prophylaxis
- Most hospitals have a DVT prophylaxis protocol
- Methods include:
- Stockings
- Calf pumps
- Pharmacological agents (e.g., low molecular weight heparin)
- No method of prophylaxis is foolproof and all have their own complications
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Description
This quiz assesses your knowledge on managing post-operative bleeding cases. It covers the importance of regular checks on vital signs, fluid resuscitation, and imaging tests to determine the extent of hematoma.
