Logistics - HPB and Surg Onc

Floor work

  • HPB only: APP (Kristan, Taylor A., or Taylor F.) helps out with floor work on M/T/Th/F (Wednesday is day off?) so that you can go to OR
  • APP will do MDR rounds for you
  • Around POD 4 can call pathology for hotseat read on path if relevant
  • Tuesday AM: Tumor board (interns don't need to go?)
  • Tuesday Noon: Surg Onc conference (sandwiches!) in IR conference room
  •   M T W Th F

    HPB
    (Visser, Dua)

    Visser OR
    Dua OR

    		 Visser PM clinic (Aa workroom) OR OR Visser/Dua clinic all day (Big A workroom)

    Surg Onc 1
    (Norton)

    OR

    		 OR Clinic (Aa workroom) ?OR ?OR

    Surg Onc 2
    (Poultsides)

    Clinic at 9AM (Big A workroom) (plan to run very late...til like 7-8 PM)

    Usually free day; sometimes OR

    PM - 'pop-up' clinic where he'll have 1-2 patients (Aa workroom)

    		 OR OR OR

OR

  • HPB: Ideally with APP around, should be able to make it to most of the cases - if you are around, will do open choles for the liver resections/Whipples
  • Norton: needs you to retract for thyroid/parathyroid
  • Pull up images on Centricity on the OR PACS computer
  • Olivia is Visser's main scrub tech, she knows all
  • To find OR scheduler: go past OR front desk and to room on left, and ask who the case scheduler for the attending is

Clinic

  • First thing to check is to make sure that patient's imaging is available if they are supposed to have it (on LifeImage, CD, etc.) - if not, then make sure to try and expedite that. If they had a scan right before clinic, call Radiology for a wet read.
  • Dictation area code: 238

Discharges

  • Attending Typical follow up Message on Epic:
    Visser 1 wk APP clinic Estedar Gizaw
    Dua 1 wk APP clinic Roxanne Jesyk
    Norton   Sara Fry
    Poultsides 2 wk Poultsides Sara Fry
  • Most will need Lovenox at discharge for 28 days total (prophylactic = 40 mg daily) - put these in a couple days before discharge for prior auth, and have them switch from heparin to Lovenox on day of/before discharge so they can receive Lovenox teaching

Common procedures

  • For pathways - Epic tab -> weblinks -> Care Paths for PDFs of pathways

Liver resection

Pre-op
  • Avoid starting TKO fluids on liver patients to minimize the amount of fluids they get
  • No heparin, no epidural (↑ risk of bleeding with ↑ INR)
 

Meds

 FEN/GI
POD 0

Vitamin K 10 mg IV in PACU

NPO

Normosol @ 1.5 mg/kg/hr
POD 1

BID CBC, INR, CMP

Limited clears

D5 1/2 NS + K Phos 30 mmol @ 125
POD 2

BID CBC, INR, CMP

Clears

D5 1/2 NS + K Phos 30 mmol @ 75
POD 3

 

PS1

D5 1/2 NS + K Phos 30 mmol @ 50
POD 4   PS2
POD 5   Regular

Whipple

Pre-op
  • Don't give heparin in case they get an epidural (most Visser pts will; Poultsides does not like epidurals)
  • Cefoxitin pre-op abx
 

Meds

 FEN/GI
POD 0

PM labs if high-risk or long/complicated operation

APAP 650 q6h, epidural

SQH BID 

Terazosin 1 mg

Pepcid 20 mg IV BID

NPO

LR @ 1 mg/kg/hr
POD 1

AM labs (CBC, CMP)

Maybe Toradol

NPO except meds

D5 1/2 NS @ 75
POD 2

Labs only if needed

Endocrine consult if BG elevated

Limited clears

D5 1/2 NS @ 50
POD 3

Pepcid IV -> Protonix PO

Check JP amylases; can pull if normal and low risk

Limited clears + Impact TID

TKO
POD 4 d/c epidural, Foley

Fulls + impact
POD 5 Lovenox discharge order for pre-auth

Post surg 1, nutrition teaching/consult
POD 6 Prep for discharge, Lovenox teaching, etc.

Post surg 2/regular
POD 7

Discharge

F/u APP clinic 1-2 weeks (message nurse coordinator)

  

Other notes

  • Distal pancs - Make sure to check BGs; endocrine c/s if elevated BG. Splenectomy vaccines before dc if applicable

 

author: admin | last edited: May 23, 2019, 6:38 p.m. | pk: 158