Common Causes of Post-Op Fever - the “5 W's” Mnemonic.
- Wind: Atelectasis (first 24-48 hrs)
- Water: UTI (after POD #3)
- Wound: Infection (usually after POD #5, Grp A Strep→POD 1)
- Walking: DVT (after POD #7-10)
- Wonder drugs: Drug fevers (anytime)
Morning Presentation
Example: “This is Mr. X who is post op day _ from a _. He complains of _. His vitals are _. His physical exam shows _. His diet is _. His meds are _. His iv fluids are _ and his urine output is _. His activity level is _. His active issues are _. The plan for Mr. X is _."
Tips:
- Streamlined and concise--not as much focus on FHx/SHx, only relevant PMH/PE
- Include post-op day and type of surgery (POD#0= day of surgery, POD#1=day after surgery)
Progress Note
ID – 73M POD 3 from R Hemicolectomy
Subjective - Past 12 hr events – (MI, transfusion, confusion, chest pain), Bowel fxn
Objective
PE Gen*
*may not necessarily have to present if focused rounds
(Labs, imaging and pathology presented in PM rounds)
A/P (Assessment and Plan): POD 3, doing well
Op Note
Sample Post-Op Orders
Post-Op Check
Pre-Operative Anesthetic Evaluation
Age / Sex / Indications and Procedure
Preoperative Assessment
Physical Exam
ASA Physical Classification 1-5
ASA 1 Patient with no systemic disease
ASA 2 Patient with mild systemic disease
ASA 3 Patient with severe systemic disease that limits activity
ASA 4 Patient with incapacitating disease that is a constant threat to life
ASA 5 Patient that is moribund and not expected to survive 24 hours
In the event of emergency surgery the letter E is added to the classification
Anesthetic Management Plan
General anesthesia vs. Regional anesthesia vs. MAC
Components
Induction agents
Maintenance agents
Emergent
Fluid management
Postoperative/PACU course
Pain management