08 / Perioperative
Before and after the knife
Most surgical learning happens outside the incision. Pre-Op is the thinking that earns the operation; Post-Op is the vigilance that protects it.
Pre-Op
Indication & history
Why this operation, for this patient, now? Every later decision hangs on this.
Consent, conceptually
Understanding in the patient's own terms: what is done, why, alternatives, and the material risks.
Fasting
An empty stomach at induction protects the airway, the aspiration logic behind NPO rules.
Medications & anticoagulation
What continues, what pauses, and why anticoagulants dominate the conversation.
Antibiotic prophylaxis
Circulating at incision, chosen for the flora of the operative field.
Imaging & site verification
The scans in the room, the site marked awake, feeding directly into the time-out.
Post-Op, the daily check
Pain
Controlled enough to breathe deeply and mobilize, analgesia is prophylaxis for lungs and veins.
Fluids & urine
The kidney is the canary of perfusion: 0.5 mL/kg/h is the number to carry.
Drains & tubes
What is it, what is coming out, how much, and has the character changed?
Wound
Inspect when the story demands it, pain, fever, discharge, not just by routine.
Gut function
Flatus, diet progression, distension: the abdomen reports its own recovery.
Mobility & prophylaxis
Out of bed early; mechanical and chemical VTE prophylaxis on the chart.
POD, the chart is the exam
Postoperative Day 2, 06:40 chart review
Bowel resection · fictional educational patient
You are pre-rounding. Tap everything on this chart that deserves your attention.