This chapter covers briefly the nutritional needs of surgical patients. Surgical patients differ from other patients in the hospital because in addition to basal metabolic demands and the increased nutritional requirements of disease and immune defense, they also have demands that result from the surgical procedure and wound healing. In many cases the normal enteral route of feeding is not available. Basic Metabolic Requirements The average…

Gastrointestinal (GI) bleeding is a stressful on-call problem to manage. It is common in hospitalized patients, and it includes a broad spectrum of disorders. GI bleeding can represent a minor problem or a life-threatening emergency. Initial management involves resuscitation, stabilization, and identification of the source. History taking, evaluation, and definitive treatment should follow in rapid sequence. Phone Call Questions 1. Where is the blood coming from,…

Surgical disease and treatment is often associated with aberrations in fluids, electrolytes, and acid–base status. Rapid fluid status assessment is a constant exercise in the management of surgical patients and the application of therapies best suited to treat respective abnormalities. The common denominator in all fluid management is the avoidance of shock or inadequate end-organ perfusion. Poor end-organ perfusion may lead to hypoxia and irreversible damage.…

All patients with fever warrant clinical investigation. Although most febrile patients in the postoperative period are not infected, the evaluation is directed toward the discovery of infection, as this is the most threatening cause. Phone Call Questions 1. How high is the patient’s temperature? A core temperature of greater than 38.5˚ C is considered significant. 2. What was the route of measurement? Temperatures taken orally are…

When a patient falls, it is a serious event. Whether the patient falls from bed or falls elsewhere in the hospital, be mindful of the following two questions after the fall: Is the patient injured? And, what was the cause of the fall? Phone Call Questions 1. Was the fall witnessed? Anyone who witnessed the fall should be contacted, and his or her story should be…

Abnormalities of heart rate (HR) and rhythm include both harmless and potentially life-threatening processes. Rate and rhythm disturbances include bradycardias, tachycardias, and irregular rhythms. Bradycardias are rhythms resulting in a ventricular rate of less than 60 beats Tachycardias are defined as rhythms with an HR of greater than 100 beats As the on-call physician, you must identify the type of rate and rhythm disturbance and the…

Reactions to medications may be wide ranging, from complaints of bad aftertaste to more serious problems with allergic reactions and anaphylaxis. Most calls will encompass three major groups of symptoms: rashes, anaphylaxis, or other complaints of patient intolerance. All drugs have side effects, and explaining to the patient what to expect before administering the drug may eliminate many calls. This is especially important when the side…

Chest pain is one of the most concerning calls you will receive. Chest pain may represent a nonserious problem such as heartburn or a life-threatening problem such as acute myocardial infarction (MI). To best handle chest pain calls, approach it the same way each time, following a logical progression in the evaluation and management of the patient to ensure all possible threats to life are evaluated.…

Phone calls regarding your patients’ bowel functions will be frequent; fortunately, many of these problems can be managed over the phone. Patients may have changes in bowel function while hospitalized because of dietary changes, less mobility, narcotic analgesics, and other medications, and abdominal surgery with functional ileus. You should be familiar with the major causes of these changes and feel comfortable with the range of options…

One of the most common calls, abdominal pain, is also one of the most difficult to evaluate. Whole textbooks have been written on the approach to abdominal pain in surgical patients. This chapter is not meant to replace those books, but it will cover many of the common calls in the hospital. Many causes of abdominal pain are benign, but one must always consider and act…

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Why write a book on surgical on-call problems? All surgical training programs require time spent “on call.” This is the time, usually overnight or on weekends, during which a physician is responsible for the care of hospitalized patients. It is also the time when new clinical problems arise. These times have extraordinary educational value, but are also the source of great stress. While on call, the…