Perioperative Care and Critical Care
Core concepts
Understand risk assessment (cardiac risk indices, frailty, nutrition), enhanced recovery pathways (ERAS), VTE prophylaxis, and perioperative antibiotic timing. Know fluid and electrolyte management, sepsis bundles, and ventilator basics. Recognize postoperative complications: anastomotic leak, ileus versus obstruction, surgical site infection, and delirium. Understand the rationale for early feeding and early mobilization, and the value of goal-directed fluid therapy.
Traps
Questions test whether you avoid routine nasogastric decompression and prolonged fasting. Another trap: treating postoperative tachycardia with fluids alone when it may signal leak or sepsis. Watch for confusion between ileus and mechanical obstruction, and the timing of VTE prophylaxis in neuraxial anesthesia. Also know that perioperative beta-blockade is not routine.
Worked example
A patient on postoperative day 5 with tachycardia, fever, and rising white count after colectomy: suspect anastomotic leak and obtain CT with contrast; do not simply increase fluids. Rule of thumb: unexplained postoperative tachycardia is a leak until proven otherwise; ERAS principles (early feeding, opioid-sparing analgesia) reduce complications.