1. 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
( ml 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