Xrays, bloods, antibiotics

 

X-Rays

  1. •All thoracotomy, thoracoscopy and mediastinoscopy patients are to have CXR in recovery and it is to be checked by the registrar.

  2. •All thoracotomy and thoracoscopy patients to have CXR daily for 5 days (or till discharge if shorter than 5 days) whether they have a chest drain or not.

  3. •All patients with chest drains to have daily CXR unless otherwise decided by Senior Registrar or Consultant.

  4. •Longterm patients to have CXR Monday and Thursday unless otherwise decided by Senior Registrar or Consultant.

  5. •On discharge all thoracotomy, thoracoscopy, pneumothorax, pleural effusion and chest trauma patients (and others where indicated) are to be given an Xray form and instructed to go to the Xray department half an hour before their designated outpatient appointment. This includes patients being referred back to Daisy Hill, Craigavon and Altnagelvin clinics (just use a RVH form). This saves time for the patient at the OPD clinic.


Blood Tests

  1. •All major cases to have FBP, U&E on first day postop. Specifically request serum creatinine as it is not on the routine U&E block of tests.

  2. •All patients on IV fluids to have daily U&E until stable.

  3. •All longterm patients to have FBP, U&E Monday and Thursday unless otherwise decided by Senior Registrar or Consultant.

  4. •If a myocardial infarct is suspected take blood immediately for CKMB and for subsequent days (CK is not adequate in the postop setting).

  5. •In case of sepsis (single temperature spike of greater than 390 C or persistently > 380 C) take two sets of blood cultures 30 minutes apart during temperature spike, FBP, MSSU, sputum culture, drain fluid and wound swabs should be taken as indicated.

  6. •Blood tests at other times as clinically indicated.


Antibiotics

  1. •Single dose prophylactic antibiotics will be administered by the anaesthetist on induction. A full table of indications for prophylactic antibiotics can be found here.

  2. •If sepsis develops take cultures as above and commence broader spectrum antibiotics (e.g. Tazocin) till sensitivities are back. Reserve Ceftazidime for cases with Pseudomonas and Imipenim for 3rd line management or cases of pneumonectomy in danger of developing ARDS.

  3. •In patients returning from RICU continue those antibiotics which are clinically indicated, but stop the routine "SPEAR" drugs (usually Cefotaxime and Flagyl).