Ward Round Notes

Fluid compartments:   The body is made of about 60% water, which is divided between the intracellular and extracellular space. Fluid is distributed in these spaces by osmotic forces determined by ion distribution between the intracellular and extraceullular space. Approximately 2/3rds (40% total body weight) of the body’s fluids is distributed in the intracellular space and 1/3rd (20%)in the extracellular space.

Resuscitation Reduction Restriction Rehabilitation Eg. A 28 y/o man arrives in ED after a motorbike accident with a fractured tibia and fibula. 1) resuscitate according to ATLS guidelines. Examine limb for neurovascular deficit once patient resuscitated. X rays with 2 views. 2) Reduction - may be closed reduction by manually pulling distal fragment to line up bone under sedation or anaesthesia, or open reduction where pins and plates are put in. Depends on type of fracture etc. Open fractures are managed differently to closed fractures. 3) Restriction - eg. using plaster of paris, External fixation, internal fixation with plates/pins etc. again dependent on injury. 4) Rehab - Encouraging mobilisation, physiotherapy, occupational therapy to help adapt environment etc. References: Gosling A, Stansby G, Surgical Talk- Surgery for Finals , London, Imperial College Press, 2004

Fresh PR bleed: Diverticulitis Benign and malignant tumour Haemarrhoids anal fissure Ulcerative colitis Angiodysplasia Trauma Coagulopathy massive upper GI bleed Non PR bleeding - mensturation, haematuria.  Malaena: Gastric ulcer Peptic ulcer Mallory weiss tear Gastritis Benign and malignant tumour Oesophageal varicies Merkel's diverticulum Dark stools without blood - iron tablets References: Ellis H, Calne R, Watson C, Lecture notes - General Surgery,  11th Ed., Oxford, Blackwell Publishing, 2006 SurgWiki, Haematemasis and Malaena, [online] available from: http://www.surgwiki.com/wiki/Haematemesis_and_melaena [accessed:20/10/2014]