Consultant: Ah, Mrs Townsend? Can you fill me in a bit about her?
RMO[1]: Sure. She’s a 45-year-old woman who came in three days ago for an open cholecystectomy. You may remember that she wasn’t a candidate for a laparoscopic cholecystectomy.
Consultant: Oh yes. I remember her now. Is there any relevant past medical history I should be aware of?
RMO: Yes. She suffered from cholecystitis for quite some time and had a very large gallstone removed a few days ago, as I mentioned before. The size of the gallstone was the main reason for open surgery rather than keyhole surgery. In addition, she has a long history of alcohol-related cirrhosis of the liver. She had a recent chest infection which was treated by her GP. I’m concerned about her now because she’s in a lot of pain, despite using her PCA regularly. She’s had quite a few breakthrough doses of analgesia but is still complaining of localised pain around the incision site.
Consultant: Mm. Her temperature?
RMO: She’s been spiking a temperature between 38 and 38.5 over the past few hours.
Consultant: OK. You said she’s got a lot of localised pain around the surgical incision?
RMO: That’s right. She seems to have more pain that one would expect, even with open surgery. One of the nurses also asked me to check her wound. She noticed that it was very red and had an offensive smell. The redness has been spreading and I’m a bit worried about the possibility of a collection or abscess.
Consultant: Yes, I see. What are her other obs like?
RMO: Her BP’s elevated and she’s tachycardic. She’s also quite breathless. Her sats are running around 95, 96%.