Intended for healthcare professionals

  1. Student
  2. Postoperative emergencies
  3. Postoperative emergencies
Student Education

Postoperative emergencies

BMJ 2007; 335 doi: https://doi.org/10.1136/sbmj.0710365 (Published 01 October 2007) Cite this as: BMJ 2007;335:0710365
  1. Rasheed Zakaria, foundation year 1 doctor1,
  2. Ashok Handa, tutor in surgery2
  1. 1Chelsea and Westminster Hospital, London
  2. 2Nuffield Department of Surgery, John Radcliffe Hospital, Oxford

The surgical junior doctor is the first person called. Rasheed Zakaria and Ashok Handa explain how to manage eight common presentations

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One of your first responsibilities as a junior doctor is the care of surgical patients in the wards. Surgical and clinical commitments may mean that your seniors are not immediately available, and in an emergency you will invariably be the first person to be called.

This article covers situations encountered commonly in patients who have had operations—shortness of breath, venous thromboembolism, pain, wound problems, confusion, transfusion reactions, nausea, and pyrexia. We hope to highlight the diagnoses you should have at the forefront of your mind, why they occur in surgical patients, how to avoid them, and how to initiate management before advice is available. As always, if in doubt, call for help.

Shortness of breath

Respiratory complications are common after surgery, especially in older patients (box 1). Be particularly vigilant for patients with pre-existing cardiac or respiratory disease, smokers, immobile patients, patients who have had a general anaesthetic, and patients who have had thoracic or upper abdominal incisions.

Box 1: Causes of shortness of breath in postoperative patients

  • Atelectasis

  • Aspiration

  • Pain

  • Pulmonary embolism

  • Infection (pneumonia)

  • Pulmonary oedema

  • Pneumothorax

  • Pleural effusion

  • Adult respiratory distress syndrome

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Minimise the risk by ensuring that patients have good analgesia. Enlist the help of a physiotherapist to give appropriate therapy and to teach the patient breathing exercises. Encourage regular changes in posture and early mobilisation.

Reassure the patient and sit them up. Give high flow oxygen. Some patients with obstructive airways disease will not tolerate 100% oxygen, but do not let this deter you from giving sick patients oxygen.1 Quickly familiarise yourself with the history and examine your patient's heart and lungs. Check pulse oximetry and consider sampling arterial blood gas. Obtain an urgent portal chest x ray film.

Tension pneumothorax

Act immediately if you suspect tension pneumothorax—trauma, …

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