SU10.1-4 | Perioperative Management — Assignment

CLINICAL SCENARIO

Mr K, a 58-year-old man with type 2 diabetes and hypertension, is listed for an elective open inguinal hernia repair. He smokes 10 cigarettes a day. You are the student attached to the surgical firm and have been asked to follow him through his perioperative journey: to help prepare him before surgery, to take informed consent in a simulated session with him, to be present and assist appropriately in theatre, and to be ready to recognise and respond to any postoperative complication. He is a little anxious and tells you, 'I just want to understand what is going to happen to me.'

Describe how you would prepare Mr K for surgery. Assign and justify an ASA physical status, and identify the perioperative risks created by his diabetes, hypertension and smoking. Explain the prophylaxis you would plan (antibiotic timing relative to incision; VTE prophylaxis by assessed risk) and outline the three phases of the perioperative sequence as they apply to him.

Set out, step by step, how you would take informed consent from Mr K in a simulated session. Show how you address each of the three pillars — capacity, voluntariness and disclosure of material information (benefits, risks, alternatives, consequences of no treatment). Explain why the signed form is the record of the process and not the consent itself, and how you would check his understanding.

Explain how the WHO Surgical Safety Checklist (Sign In, Time Out, Sign Out) protects Mr K, naming what is confirmed at each phase. Then describe your role as an assistant: who belongs to the sterile team, how you maintain the sterile field, and the single most useful thing you can do to help the surgeon (keeping the field exposed and dry).

Mr K has a small skin laceration on his forearm that also needs suturing. Describe how you would anaesthetise and close it safely, stating the correct maximum lignocaine dose (3 mg/kg plain, 7 mg/kg with adrenaline) and calculating it for his weight if given. Address tetanus prophylaxis and the decision to close by primary versus delayed/secondary intention. Finally, describe the early signs you would watch for if he began to bleed postoperatively and your immediate response.