UHS EMERGENCY LAPAROTOMY PATHWAY For all patients who may need: Non-Elective Open or Laparoscopic Abdominal Surgery. Excluding appendicectomy and cholecystectomy. MEWS ≥ 4 Early Surgical Review (post MRCS) TIME TARGETS from patient admission Calculate MEWS Lactate/Bloods/ECG IV fluid resuscitation Screen and Treat for Sepsis Fluid resuscitation 1ml/kg/hr crystalloid (+ 250-500ml bolus for hypotension) 30 min See TRUST MICROGUIDE for definitions of low / high risk patients or alternatives including for penicillin allergy LOW RISK Cefuroxime 1.5G IV TDS Metronidazole 500 mg IV TDS HIGH RISK Tazocin 4.5G IV TDS Gentamicin 5mg/kg STAT (consider Vancomycin if MRSA +) if required Administer 1st dose ANTIBIOTICS Order CT Scan 1 hour 4 hours CT Scan reported Calculate P Possum (& record on consent form) Senior Review (Senior ST/Consultant) SURGICAL DECISION URGENT/IMMEDIATE LAPAROTOMY Complete ‘Boarding Card’ Contact Anaesthetist: bleep2265 If PPossum >5% Discuss with ICU Ensure consultant surgeon & anaesthetist in theatre If PPossum >10% - arrange ICU admission CONSERVATIVE MANAGEMENT Regular Senior Review +/- EXPEDITED LAPAROTOMY 10 hours PATIENT IN THEATRE