Many postoperative patients will have drainage devices to facilitate their care. The types used most often fall into the following broad categories: Chest tubes Urinary drainage tubes (urinary catheters) Gastrointestinal (GI) tubes (nasogastric [NG], feeding tubes, and gastrostomy and jejunostomy…
Trauma describes injuries caused by physical forces. These may be blunt, penetrating, thermal, or any combination of the three. As the leading cause of death in patients under 45 years of age, it is imperative that the on-call surgeon be…
Syncope is a brief loss of consciousness caused by an interruption of cerebral blood flow. Causes range from benign processes such as vasovagal episodes to more serious conditions such as dysrhythmias. As the on-call physician, your job is to identify…
It is common to be asked to assess problems with a patient’s breathing. Shortness of breath (SOB) has many causes. Most at risk to develop respiratory distress are those who have had thoracic or upper abdominal procedures, and elderly, obese,…
Seizure activity is a synchronous discharge of electrical activity in the brain. The locus in the brain dictates what clinical symptoms are noted. Generalized tonic-clonic seizure activity is the major symptom for which you will be called. Seizure activity is…
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…