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Elias Bergman
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… / 27 pts
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History of Presenting Complaint
Marking 5 pts of criteria...
Clarifies timing and onset of nausea/vomiting relative to surgery and medication administration
Asks about frequency, volume, and appearance of vomitus (including bile or blood)
Enquires about aggravating/relieving factors (e.g., relationship to oral intake, position)
Screens for associated symptoms (abdominal pain beyond surgical site, fever, chills, chest pain, neurological symptoms)
Asks about ability to tolerate oral fluids and presence of dehydration symptoms
Past Medical History, Medications, and Allergies
Marking 3 pts of criteria...
Identifies relevant past medical history (e.g., diabetes, GERD, history of PONV or motion sickness)
Reviews current regular and perioperative medications (including opioids, anti-emetics, and home medications)
Inquires about drug allergies and adverse reactions
Physical Examination
Marking 5 pts of criteria...
Performs general inspection for distress, dehydration (dry mucous membranes, reduced skin turgor), and overall appearance
Measures and interprets full vital signs (HR, BP, RR, temperature, O2 saturation)
Inspects the surgical site for signs of infection or complications (erythema, swelling, discharge)
Performs focused abdominal examination (palpation for tenderness, guarding, peritonism, auscultation for bowel sounds)
Assesses for evidence of fluid status (e.g., capillary refill, peripheral pulses, JVP)
Differential Diagnoses and Clinical Reasoning
Marking 3 pts of criteria...
States common causes of PONV (anaesthetic agents, opioid analgesia, surgical factors)
Considers less common but serious complications (bowel obstruction, intra-abdominal sepsis, aspiration, myocardial infarction)
Provides rationale based on clinical findings for most likely diagnosis
Investigations and Monitoring
Marking 3 pts of criteria...
Identifies need for basic investigations if indicated (U&Es, glucose, FBC, LFTs)
Requests or reviews relevant imaging if red flags present (e.g., abdominal X-ray/ultrasound)
Plans appropriate monitoring (fluid balance, input/output charting, repeat observations)
Management Plan
Marking 4 pts of criteria...
Proposes appropriate initial management (e.g., anti-emetics, IV fluids, NPO if severe vomiting)
Considers withholding or adjusting opioids and seeking alternative pain management
Outlines criteria for escalation (persistent vomiting, signs of sepsis, suspected surgical complication)
Plans appropriate follow-up and reassessment
Communication and Professionalism
Marking 4 pts of criteria...
Explains diagnosis, management, and rationale to patient using clear, non-technical language
Addresses patient’s concerns and provides reassurance regarding expected post-op symptoms
Checks for understanding and encourages questions
Maintains professional demeanor and respectful interaction