Differences

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--- resident:nightfloat [2020/06/27 17:06] – created jonathan
+++ resident:nightfloat [2021/02/24 21:15] (current) – jonathan
@@ Line 1: / Line 1: @@
 ==== Nightfloat ====
-Your biggest job will be to check on the flaps overnight and make sure they are doing okay. If there is a problem, the ON CALL plastics resident will want to know as quickly as possible. A "heads up" text that you are going to see a flap in trouble is always a good move. If something is wrong, you must make contact with the ON CALL resident. Call or page.
+Your biggest job will be to check on the flaps overnight and make sure they are doing okay. If there is a problem, the ON CALL plastics resident will want to know as quickly as possible. A "heads up" text that you are going to see a flap in trouble is always a good move. If something is wrong, you must make contact with the ON CALL resident. Call or page.\\
+\\
 When evaluating a flap, here are the things to look for:\\
-Arterial: There will be a doppler box in the room and you need to look for the marked stitch.
+Arterial: There will be a doppler box in the room and you need to look for the marked stitch. \\
-Venous: There is a box in the room called the venous coupler. Please make sure it sounds like a sea shell up to your ear and that it modulates when the patient takes a breath.
+Venous: There is a box in the room called the venous coupler. Please make sure it sounds like a sea shell up to your ear and that it modulates when the patient takes a breath.\\
-Oxygenation: If there isn't a venous coupler, the patient should have a machine called vioptix. This is basically a pulse-ox. Report the oxygenation percentage and the signal strength. Flaps are in trouble if there is a sudden drop.
+Of note, a cook doppler and venous coupler cannot be on at the same time.\\
-Color: Is the flap pink, pale or blue?
+Oxygenation: If there isn't a venous coupler, the patient should have a machine called vioptix. This is basically a pulse-ox. Report the oxygenation percentage and the signal strength. Flaps are in trouble if there is a sudden drop.\\
-Capillary refill: How long does it take for the flap refill with blood? Normal is 2 seconds. Brisk means venous congestion. Sluggish means arterial compromise.
+Color: Is the flap pink, pale or blue?\\
-Temperature: Is the flap warm or cold?
+Capillary refill: How long does it take for the flap refill with blood? Normal is 2 seconds. Brisk means venous congestion. Sluggish means arterial compromise.\\
-Drains: What are the drains putting out?
+Temperature: Is the flap warm or cold?\\
+Turgor: Is the flap soft or hard like a rock?\\
+Drains: What are the drains putting out?\\
+\\
+Photos\\
+It is important to take "macro" photos. For example, if a patient has chest reconstruction surgery, please uncover both sides of the patient and take a direct frontal view (not oblique) that includes both shoulders and the belly button. This is super important for us to compare both sides and get the big picture. Phone photos are such good resolution now that we can zoom in on the site of interest. This also goes for example the leg, please include the thigh, lower leg and foot in the photos.\\
+\\
+Dressings\\
+Get triple of what you think you need.\\
+Dressing changes should always have silk or medpore tape ready.\\
+Common dressing changes include xeroform, bacitracin (have to order), kerlix, ABD pads, ACE.\\
+\\
+Example of Venous Congestion. Left side is purplish. Note this can be more subtle to see in dark skinned individuals. This is an emergency.\\
+{{:resident:venous_congestion.jpg?400|}}