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--- resident:nightfloat [2020/06/27 17:07] – jonathan
+++ resident:nightfloat [2021/02/24 21:15] (current) – jonathan
@@ Line 6: / Line 6: @@
 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.\\
+Of note, a cook doppler and venous coupler cannot be on at the same time.\\
 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.\\
 Color: Is the flap pink, pale or blue?\\
 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.\\
 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|}}