Critical Care and Postoperative Management
What you must understand
Postoperative care focuses on recognizing and treating complications: respiratory failure, aspiration, atelectasis, pneumonia, postoperative nausea and vomiting, delirium, and surgical complications. Know the criteria for ICU admission and the principles of mechanical ventilation (lung-protective, weaning, spontaneous breathing trials). Understand sepsis and septic shock management (fluids, vasopressors, antibiotics, source control) and the Surviving Sepsis principles. Learn about acute kidney injury, fluid and electrolyte management, and transfusion thresholds. Understand postoperative pain management and the transition to chronic pain prevention. Know delirium risk factors and prevention.
Traps in questions
Common traps: assuming a normal SpO2 excludes respiratory failure (consider hypercapnia); treating all hypotension in sepsis with fluids alone (vasopressors are often needed early); and forgetting that postoperative delirium is often hypoactive and missed. Watch for transfusion questions - restrictive thresholds are generally preferred in stable patients. Also distinguish PONV prophylaxis from rescue treatment.
Rule of thumb
For any deteriorating postoperative patient, use an ABCDE approach and ask "is this surgical, anesthetic, or medical?" Sepsis: fluids first, then vasopressors if MAP remains low, plus antibiotics and source control.
Worked example: A patient on POD 1 has tachycardia, hypotension, and fever. Consider sepsis or hemorrhage; assess lactate, start fluids, and escalate to vasopressors if needed while investigating the source.