DEPARTMENT OF SURGERY

Negros Oriental Provincial Hospital

CLINICAL PATHWAY FOR PENETRATING ABDOMINAL TRAUMA

PHYSICIAN’S POST-OP ORDER SHEET

Inclusion criteria: All patients presenting with penetrating (GSW/SW/impalement) abdominal trauma WITH CLINICAL SIGNS
OF PERITONITIS
Expected LOS: _____ Days
Exclusion criteria: no signs of peritonitis, significant comorbidities
Date : : Day ______
Patient’s Name Age: Weight: Hospital #:

Last Name First name Middle

Name EBL:

Duration of Procedure:
ORDERS
PHYSICIAN’S NOTES: Transfer to PACU Variance Sign
S: Subjective Complaints/ Symptoms
Vital Signs Monitoring Q hourly
Intake and Output Q hourly

Diagnostics/ Procedures:
€ CBC
€ Urinalysis
€ Chest Xray PAL
O: Objective, Physical/ Lab Findings € Serum creatinine
VS: € BUN
BP: HR: RR: € 12 L EKG
T: € CBG
€ ABG
C/L: € Protime, APTT

Abd:
IVF with double line with:
________________________________________
Rectal:
Start meds:
GCS: € Cefuroxime 750mg IVTT q 8h
€ Metronidazole 500 mg IV drip q 8h
€ Piperacillin-Tazobactam 4.5g IVTT q8H
€ Ranitidine 50 mg IVTT q 8h
A: Assessment/ Working Impression/ € Tramadol 50 mg IVTT q 6h
Clinical Diagnosis € Tetanus Toxoid 0.5mL IM
(if not given preop)
Penetrating abdominal trauma € Tetanus Ig 250 IU IM
(if not given preop)
P: Plan of Care

Diagnostics/ Imaging: Diet: NPO

CBC, Blood typing, CT scan of the
abdomen(if warranted) Activity: Complete bed rest without toilet privileges

Therapeutics: Consults/ Co-management orders:

Surgery done ● Refer to Anesthesia for post-op orders
€ Exploratory Laparotomy
€ DCS
Provide for psychosocial needs
Antibiotic therapy ● Patient appraised of the clinical situation
and the need for emergency surgery and
also appraised of the risk, benefit and
possible complications

Provide patient/Family education

Patient’s family appraised of current situation

Discharge Plan:
Discharge if without complications once with
normal GI function
 Take home medications, wound care and follow up
instructions to be given

Activated by: Acknowledged by:

______________________ ________________________
Surgical Resident on Duty Nurse in charge

NOTE: THIS PATHWAY WILL BE ACTIVATED ONCE SIGNED BY THE SURGICAL RESIDENT ON DUTY AND NURSE IN
CHARGE AND SHOULD BE STOPPED WHEN AN ADVERSE REACTION IS NOTED.

● Both AP and NIC must sign at the bottom of the pathway form to activate it
● The pathway will be discontinued by anyone whenever:
1. The patient’s primary diagnosis changes

2. The patient’s condition significantly worsens

3. The patient fails to meet clinical outcomes for 24-48 hours

● Variance codes:

A. PATIENT/FAMILY B. CLINICAL C. SYSTEM D. COMMUNITY

a.1 Non-adherence to b.1 Development of a c.1 Lack of available d.1 Unable to contact
plan of care new medical Equipment / Community Health
a.2 Patient or family /surgical problem Medicines Service
refuses discharge b.2 Exacerbation of c.2 Failure to perform a d.2 Delay in availability
a.3 Financial constraints underlying condition recommended of recommended
a.4 Home per b.3 Delay in response to procedure support
request/against medical treatment c.3 Delay in response to
medical advice interdepartmental
a.5 Absconded referral (co-
management,
consult, or transfer
of service)