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Resuscitation Unit

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udreanimacion RESUSCITATION UNIT

FUNCTIONS
  • Haemodynamic and metabolic monitoring of the patient
  • Post-surgical follow-up
  • Treatment of postoperative pain

The number of operations that are performed with locoregional anaesthesia is on the increase, but post-anaesthesia care should be similar to the care received by general anaesthesia patients in terms of the degree of post-operative monitoring and surveillance.

ADMISSION CRITERIA
  • The aggressiveness of the actual surgery
  • Patient's preoperative condition/s
  • Intensity of the postoperative pain

These factors prevent the patient from being monitored as is usual in the ward.

Patient admission:

The patient's Clinical History is opened to ascertain:

  • Relevant medical and surgical history
  • Previous surgery
  • Reason for admission
  • Clinical examination
  • Prescribed treatments and controls

The nurse assesses post-anaesthetic condition on the Aldrete scale and recalculates it every 15-30 minutes to document the patient's improvement or deterioration. In neurological patients, the Glasgow scale and pupillary control are used.

CONTROLS AND THERAPIES

Routine monitoring in this Unit includes breathing pattern and frequency, ECG, blood pressure, temperature, pulse oximetry, diuresis and electrolyte balance. If there is a significant previous pathology and/or aggressive surgery has been performed, more invasive controls are carried out, such as direct blood pressure, hourly diuresis, CVP and/or PCP.

Special emphasis is placed on the monitoring of hypothermia and tremors. Post-surgical patients are at risk of hypothermia through exposure to low temperatures in the operating theatre, open-chest and or -abdomen surgery, fluids and/or blood infusion and transfusion, washing with cold disinfectant solutions and anaesthesia. This control is carried out with heated and humidifier blankets and/or small doses of intravenous dolantin.

The basic analytical control on admission includes a blood panel, coagulation, renal function, ionogram, glycaemia and usually arterial blood gases.

Individualised controls:

Controls are subsequently individualised, and may include:

  1. In diabetes mellitus, blood sugar is controlled every hour, and the treatment, either with subcutaneous or intravenous insulin in continuous perfusion, is adjusted to the results.
  2. Natremia is controlled systematically after techniques that may involve significant water reabsorption (hysteroscopy, transurethral resections) or SIADH (inappropriate antidiuretic hormone syndrome) may appear (pituitary neurosurgery).
  3. Calcaemia is always monitored after thyroid/parathyroid surgery.
  4. Magnesemia and osteotendinous reflexes are monitored virtually routinely, every 12/24 h, in patients on treatment with magnesium sulphate (Preeclampsia/Eclampsia).

As far as prescribed therapiesare concerned, anti-thrombotic, anti-emetic and antibiotic prophylaxis is applied whenever the patient's condition or the surgery so require. Postoperative pain is treated aggressively according to the Department's healthcare protocols; on many occasions this treatment begins in the operating theatre through epidural, plexus or peripheral catheters placed pre-operatively.

The water-electrolyte balance and blood volume are monitored closely montrolled by physical examination and repeat analyses; in general, only patients with Hb ≤ 7 gr/dl and/or hemodynamic instability attributable to hypovolaemia receive transfusions.

Early respiratory physical therapy is crucial in the prevention of postoperative pulmonary complications, such as atelectasis, pneumonia and hypoxaemia, and it is routinely prescribed in risk patients (COPD, obese, smokers, OSA syndrome) and/or after upper abdomen laparotomies or thoracotomies.

Finally, depending on the patient's condition and/or the nature of the surgery, early parenteral nutrition is initiated with case-specific appropriate calories and grams of nitrogen.

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