CICM SAQ 2015.2 Q13

Maintain ABCs

• Monitoring of vital signs
• SpO2 and ABGs for PCO2
• Use of CPAP post op if required. May use patient’s own CPAP device but issues with leak, need for
  oxygen supplementation, etc. may require ICU machine usage
• Monitor electrolytes especially K+, urine output

Maintain hydration

• Appropriate fluids can be Hartmanns, 5% glucose, dextrose saline all of which will provide an
  energy substrate and avoid starvation ketosis

Maintain euglycaemia (BSL 4-10)

• Insulin either as an intravenous infusion or intermittent sub-cut bolus to maintain BSL 4-10. No
  evidence even in this group to support tight BSL control

Avoid starvation ketosis

• Post-operative oral fluids or diet should be discussed with surgical team and appropriate diet
  commenced as soon as practical

Housekeeping

• Adequate analgesia avoiding opioids
• DVT prophylaxis- mechanical prophylaxis for all with low molecular weight heparin if no
  contraindications.

Positioning

• Ensure appropriate posture/positioning in bed to optimize respiratory function and minimize gastro-
  oesophageal reflux and for pressure care
• Early mobilization is essential. Goals should be set in conjunction with physiotherapy staff including,
  for example, sitting out of bed within 18 hours, walking within the next 24 hours.
• Special bariatric beds required and may also need large chairs so patients can be sat out of bed.
• Hoists etc. / manual handling training for staff

Surgical

• Test for leak as per surgical protocol e.g. ice water test, gastrograffin swallow.