Professional Documents
Culture Documents
Post Op Care
Post Op Care
Post Op Care
READ!
Recommended Reading:
McGlamrys text
Post-operative complications and considerations section (pg 1997)
Usually small sections at the end of specific surgical chapters Clinics in Podiatric Medicine and Surgery editions Residency Interview Study Guides
Presby manual Crozer manual Goldfarb board review PRISM
You are not a used car salesman! You should never attempt to sell a patient on surgery. In just about all situations, elective surgery is a last resort.
Give a specific example of what restraining devices to expect: Need to break it down and be
Put on a cast for a week! Any pins sticking out of the foot?
basic with your patients. give them a specic list of activities they are not going to be able to perform.
Mrs. Feynman, I have to make the commitment to perform the surgery and you have to make the commitment to allow it to heal in the correct position.
very rarely the rst time you meet someone they will do surgery. elective surgery should be the last resort.
100%:
100%
~10%:
than when we started, Chronic pain state, Infection requiring antibiotics or surgery, Skin healing problems, Bone healing problems, Need for future surgery, Overcorrection, Undercorrection, Recurrence, Need for removal of hardware, Nerve damage, Stiffness, Decreased motion, etc
100%
~10%:
come up with a list as many potential complications as possible when doing surgery
than when we started, Chronic pain state, Infection requiring antibiotics or surgery, Skin healing problems, Bone healing problems, Need for future surgery, Overcorrection, Undercorrection, Recurrence, Need for removal of hardware, Nerve damage, Stiffness, Decreased motion, etc
Be extraordinarily careful and basic with your language when explaining surgery to a patient. Always remember your very first day in clinic!
100% ~10%
<1%:
-You having a reaction or allergy to the anesthesia that we didnt know about and it kills you. -You developing a blood clot that goes to your heart or your lungs and it kills you. -You developing an infection so bad that we have to amputate your toe or your foot.
100% ~10%
<1%:
The chances of these things happening are about the same as you getting into a fatal car accident driving to or from the surgery, but they are a risk that you wouldnt take by not having surgery.
-You having a reaction or allergy to the anesthesia that we didnt know about and it kills you. -You developing a blood clot that goes to your heart or your lungs and it kills you. -You developing an infection so bad that we have to amputate your toe or your foot.
READ!
Austin DW and Leventen EO.
What type of internal fixation for the osteotomy is recommended for this procedure?
Partial weight bearing (PWB) To heel; To heel for transfers; To forefoot 20%; 50%; 75%; etc. Full weight bearing (FWB)
Cast Know what the acronym for CAM stands for CAM walker Posterior splint Surgical shoe
Full; Half; Rockerbottom
Partial weight bearing (PWB) To heel; To heel for transfers; To forefoot 20%; 50%; 75%; etc. Full weight bearing (FWB)
Partial weight bearing (PWB) To heel; To heel for transfers; To forefoot 20%; 50%; 75%; etc. Full weight bearing (FWB)
Post-Operative Assessment
Documentation: NORMAL Ms. Feynman returns 2 weeks s/p right 2nd digit hammertoe surgery NWB in an intact posterior splint.
First line of post op note. Must be very specic in the note. What is the weight bearing status and hiow are they being
Post-Operative Assessment
Documentation: NORMAL Ms. Feynman returns 2 weeks s/p right 2nd digit hammertoe surgery NWB in an intact posterior splint, or Ms. Feynman returns 2 weeks s/p right 2nd hammertoe surgery PWB in a surgical shoe with an intact dressing.
Post-Operative Assessment
Documentation: NORMAL ABNORMAL
Ms. Feynman returns 2 weeks s/p right 2nd digit hammertoe surgery NWB in a posterior splint, or Ms. Feynman returns 2 weeks s/p right 2nd hammertoe surgery PWB in a surgical shoe with an intact dressing, or
Ms. Feynman returns 2 weeks s/p right 2nd digit hammertoe surgery WBAT in her regular sneakers and without a bandage.
possibly cc--tired
3,4,5 are fractured. if there is some type of fracture the patient is going to be weight bearing.
How long?
How long?
If a patient is NWB, then should you cut off the cast and walk them to x-ray?
How long?
Somewhere between 2-8 weeks. Usually at least until the sutures have been removed, edema has resolved, and all pins have been removed from the foot. And not any longer than after you have radiographic evidence of osseous consolidation.
use your nger to move skin around to see what the strength is. just gently move it back and forth and see if it stays together or if it doesnt stay together.
Want to assess for capillary refill of the dorsal and plantar flaps, as well as a subjective assessment of temperature of the flap, color or the flap, and the integrity of the sutures.
this looks good compaired to the other slides
Objectify!: Measure circumference to compare edema to the contralateral side and between visits.
Metatarsal heads Metatarsal bases Malleoli
Homans sign: Calf pain with ankle dorsiflexion Pratts sign: Calf pain with calf compression
Virchows Triad: Hypercoaguable state, Immobilization, Vessel Wall Injury I AM CLOTTED: Immobilization, Afib/CHF,
Malignancy/MI, Coagulopathy, Longevity (age), Obesity, Trauma, Tobacco, Estrogen/BCP, DVT/PE History
Classic triad: Shortness of breath, Chest pain, Hemoptysis Diagnostic test: Spiral CT scan
READ!
Shibuya N, Frost CH, Campbell JD, Davis ML, Jupiter DC.
Incidence of acute deep vein thrombosis and pulmonary embolism in foot and ankle trauma.
J Foot Ankle Surg. 2012 JnaFeb; 51(1): 63-8. (Pubmed ID#: 22196459)
Recommended Reading
If there is a hole in your body the natural response is to be inammed. a little bit of erythema surrounding an incision is normal.
cellulitis is erythema that is coming from infection. erythema is usually just 1-2cm around a wound. more pinkish than red and it is relatively small. cellulitis is a lot deeper of a red and it is more 'deeper'.
Erythema
Vs.
Cellulitis
Erythema
Vs.
Cellulitis
Potentially Abnormal:
Cellulitis
Lymphangiitis/Streaking Mark it and date it!
Hot foot
Sensitive Hands/1 C
Edema
Potentially Abnormal:
Cellulitis
Lymphangiitis/Streaking Mark it and date it!
Hot foot
Sensitive Hands/1 C
Edema 5 Cardinal Signs of Inflammation/Infection: Dalor (pain) Calor (heat) Rubor (redness) Tumor (swelling) Functio Laesa (loss of function)
know this
Laboratory work
Complete Blood Count (WBC)
5 Ws of Post-Operative Fever
know this
Wind: Atelectasis, Aspiration Pneumonia, PE Water: UTI, dehydration, constipation Walk: DVT Wound: Surgical site infection, Thrombophlebitis (IV site), pain Wonder Drug: Usually antibiotics and heparin
5 Ws of Post-Operative Fever
Wind: Atelectasis, Aspiration Pneumonia, PE Water: UTI, dehydration, constipation Walk: DVT Wound: Surgical site infection, Thrombophlebitis (IV site), pain Wonder Drug: Usually antibiotics and heparin
Is the bandage too tight? What type of pain is it (aching?, sharp?, spasming?) Is something else going on?
on test
Post-Operative Assessment
Documentation: NORMAL
learn how to write a real note not just EMR
The bandage is clean/dry/intact on inspection. The incision is clean and coapted with all sutures in place. There is mild periwound erythema, but no cellulitis, drainage, nor malodor. There is moderate edema, but within normal limits of post-operative course. Calf is soft and non-tender.
Post-Operative Assessment
Documentation: ABNORMAL
Bandage: Absent, Dirty, Dishelved, etc Incision: Dehisced, Gapped, Open, etc Partial or Full thickness? Where? Sutures: Pulled out Peri-incision: Maceration, Cellulitis, Drainage, Edema, etc
Where and to what level? Streaking? What type of drainage?
Questions?
Please do not hesitate to contact Dr. Meyr if there is anything at all that that he can do for you:
AJMeyr@gmail.com