Bleeding in the postoperative period is a concern for the on-call physician. You must decide whether the bleeding has a surgical cause (major vessel bleeding) or a medical cause (abnormal coagulation status). Some patients will require a return to the…
One of the most unpleasant requirements of on-call responsibilities is pronouncing death. This important task represents a significant medicolegal responsibility. You may not have had much experience evaluating recently deceased persons, and there is some controversy as to what exactly…
Surgical patients have pain. Pain may be caused by a disease state or the therapies used to treat that disease state. Historically, pain has been under-recognized and undertreated, but recent emphasis by regulatory and government groups has brought into focus…
Nausea and vomiting are common on-call problems. There are many causes of nausea and vomiting. It is believed that the medulla contains two distinct centers that mediate vomiting, a chemoreceptor zone and a vomiting center. Toxic substances, drugs, and input…
The patient’s cognitive functioning is the most complex of all physiologic processes, and it is therefore affected by derangements in many organ systems. Appropriate assessment of mental status changes requires a knowledge of a prior mental status examination. This information…
Leg pain is common with lower extremity surgery, trauma, vascular problems, inflammatory or degenerative conditions, infection, or referred pain. Some of these conditions can be managed by telephone, whereas others require that you examine the patient. A careful discussion with…
Intravascular access is a means to administer fluids and medications and is a valuable tool for gathering hemodynamic information. The loss of “access” is a common reason for a phone call. This chapter provides orientation to various types of intravascular…
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Hypotension is a common and serious complication of a patient’s hospital course. In mild and early stages, there are many compensatory responses that can support tissue perfusion. If it worsens, circulatory collapse can ensue, resulting in shock. Shock is the…
The goal on call is to treat hypertensive episodes that are symptomatic or that put the patient at risk for myocardial infarction (MI), stroke, or bleeding. As the on-call physician, it is best to leave the fine-tuning of a patient’s…