Download PDF: Clinical Communiqué March 2016 Edition
In this edition
Case #1 POST-OPERATIVE PAIN – WHEN TO WORRY?
Case #2 BUT THE OPERATION WAS MONTHS AGO!
Case #3 DON’T DISMISS THE ENLARGING BRUISE
Expert Commentary RECOGNISING VASCULAR COMPLICATIONS AFTER ANGIOGRAPHY – A WORK IN PROGRESS
In our first issue for 2016, we look at three cases where deaths occurred as a result of complications arising from day procedures. None of the cases were urgent and in two cases the procedures were sought by the patients for cosmetic benefits and perceived lifestyle enhancement.
Although the cases differed in the type of procedure being performed, common to all three was the failure to recognise rare complications. The seriousness of the evolving symptoms and signs were not fully appreciated by the patients or the clinicians until it was too late. Some of this can be attributed to knowledge gaps on the part of the doctors involved. Much of it can be related to inadequate discharge planning and poor post-operative communication.
Pain is a symptom that is often central to a patient’s presentation to their treating doctor. Pain can be difficult to describe and even more difficult to interpret. It is generally expected to occur after most surgical procedures and there can be enormous variability in an individual’s response to pain. The spectrum of pain that might be anticipated in the post-operative period is wide-ranging and depends on many different patient and procedure variables. None theless, there are three features that reliably indicate that something is clinically wrong: 1) pain that is not adequately controlled by a medication regimen that would be sufficient for the majority of patients who have undergone that particular procedure; 2) pain that is worsening in severity rather than improving over time (even accounting for anaesthetic or long-acting analgesic medications given in the peri-operative period that have since worn off); and 3) pain that is out of proportion to the physical findings. Any of these features of the patient’s pain should prompt more questions in the doctor’s mind about the possible underlying problems.
The majority of post-operative complications occur in the early post-operative period, at a time when treating doctors are more cognizant of the potential link between a recent procedure and a new symptom. In some situations however, the risk of post-operative complications can endure long after the patient has recovered from a specific procedure. As the second case demonstrates, in certain scenarios, there is a life-long need for the procedure and its latent risks to be understood by patients, and recognised by their general practitioners who will be providing care for them in the long-term.
The expert commentary in this issue has been written by Dr Nick Collins, an experienced consultant cardiologist and proceduralist. He presents an informative and practical summary of the vascular complications after angiography, and reminds us all to have a low threshold for communicating with the proceduralist.
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