Mare Nostrum

Post-op Default (Surgery)

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Post-op Default (Surgery)

🃏 Order set for Post-op Oliguria (Explore Laparotomy)

  • Vital signs trend post-op — fever: immediate (atelectasis/drug reaction) vs day 1-3 (wound/ATB) vs day 4-5 (DVT/PE/deep abscess) vs day 7+ (wound infection/anastomotic leak)
  • Post-op fever causes (5W’s): Wind (atelectasis/pneumonia), Water (UTI), Wound (infection), Walk (DVT), Wonder drugs (drug fever) + anastomotic leak (GI)
  • Urine output — เป้า >0.5 mL/kg/hr; oliguric post-op = ให้ fluid challenge first ก่อนหา AKI cause
  • Bowel function — first flatus (day 2-3 open; day 1-2 lap), first stool; ileus vs obstruction
  • Pain control adequacy — VAS score; under-controlled pain → ไม่ยอม deep breath + cough → atelectasis

🕐 One-Day Orders

🔬 Investigation

  • Vital signs q4-6h (BP, HR, SpO₂, temp, RR)
  • Urine output q1h via foley
  • CBC, BUN/Cr, electrolytes — day 0 post-op baseline
  • Drain output — document volume + character

💊 Medication

  • IV maintenance fluid (LR 1-1.5 mL/kg/hr) — หลัง hemostasis; ลดเมื่อ oral OK
  • O₂ via nasal cannula 2-4 L/min — ถ้ายัง sedated/SpO₂ marginal
  • Multimodal analgesia:
    • Paracetamol 1 g IV q6h scheduled
    • Tramadol 50-100 mg IV q6h PRN
    • Ketorolac 30 mg IV q8h ถ้า renal OK (24-48h only)
  • Ondansetron 4-8 mg IV q8h PRN (PONV)
  • Omeprazole 40 mg IV/PO OD — stress ulcer prophylaxis
  • Wound care: dry, clean dressing day 1

🔁 Continuous Orders

🔬 Investigation

  • CBC, electrolytes day 1-2 — trend Hb, K⁺ (fluid shifts)
  • ถ้าไข้ day 3+: CBC + CRP + blood culture + wound swab (source workup)
  • CXR ถ้าไข้ + respiratory distress — pneumonia, pleural effusion, atelectasis

💊 Medication

  • IV→PO analgesia switch เมื่อ tolerating oral: Paracetamol PO ± NSAIDs
  • LMWH (Enoxaparin 40 mg SC OD) — VTE prophylaxis ตลอดเข้านอน; extended 28 วัน ถ้า cancer/pelvic surgery
  • Early oral feeding (ERAS) — clear liquid 4h post-op ถ้า tolerating; full diet เมื่อ bowel sounds + no ileus
  • Remove NGT/foley เมื่อ no longer needed (ERAS)
  • Early mobilization day 1 — 30 min OOB; prevent VTE + pneumonia + ileus
  • Stitch removal: 7-10 วัน (abdominal wall), 14 วัน (leg), เร็วกว่าถ้า staples

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