Postoperative nausea and vomiting: development of a management protocol.
Paech MJ. Pavy TJ. Kristensen JH. Wojnar-Horton RE.
Department of Anaesthesia, King Edward Memorial Hospital for Women, Perth, Western Australia.
Postoperative nausea and vomiting (PONV) is still an important and common problem. Despite the introduction of new antiemetic drugs, the management of PONV remains difficult. In this article we describe the development and evaluation of a management protocol for PONV, which consists of a treatment algorithm accompanied by a nursing education program. Implementation of this management protocol has been well-accepted by staff, appears to have reduced delay in patient treatment and improved patient care, and has significantly reduced staff workload. It is planned to use continuous quality improvement techniques to further refine the algorithm and continue assessment of its efficacy and of patient satisfaction.
Pneumothorax and pneumomediastinum during colonoscopy.
Albury Base Hospital, N.S.W.
A case of bowel perforation during diagnostic colonoscopy is reported. This resulted in the sudden appearance of massive subcutaneous emphysema of the neck, causing acute upper airway obstruction which necessitated urgent endotracheal intubation. Large bilateral pneumothoraces and pneumomediastinum were also present.