By Christine Padesky
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Extra resources for Clinician's Guide to Mind Over Mood
Older methods involved weighing the patient before and during or after surgery in order to estimate blood loss. Colorimetric methods involve estimating the haemoglobin concentration of blood-soaked ﬂuid and washing the blood-soaked gauzes in a known volume of isotonic ﬂuid. This gives the approximate blood loss. g. using the Hemocue discussed above, measure the haemoglobin from a tiny blood sample from the patient and are very accurate. g. surgical) where the haemoglobin concentration drops below 7–8 g/dL.
The aim is to have a pain score of less than 4 before discharging the patient to the ward. Objective assessment includes observing the patient’s expression (grimacing, wincing), purposeful movements towards the surgical site, and parameters such as heart rate (usually increases but occasionally decreases), blood pressure (increases) and respiratory rate (increases except when depressed due to opiates). Urinary retention and a full bladder are common causes of postoperative restlessness but are often overlooked.
Hypothermia is deﬁned as a core temperature of less than 36 °C. The prevention of inadvertent hypothermia should begin on the ward before surgery. Patients are at particular risk of developing hypothermia if they are high-risk surgical candidates (American Surgical Association (ASA) grade II+), are undergoing major surgery, or have a risk of developing cardiovascular complications. Such patients should be kept warm before theatre; this may involve simple Further reading 19 measures such as wrapping up well, but it could also include active heating, for example with forced air warming.