Clinical scenario traineeportal

Question 1

What is NELA

Answer 1

The NELA risk calculation tool provides an estimate of the risk of death within 30 days of emergency abdominal surgery. It has been developed using the data gathered from patients entered into the National Emergency Laparotomy Audit between December 2016 and November 2019. The model is an estimate taking into account the risks of the procedure and information about the patients. Not every factor which may affect outcome is included and so there may be other patient, surgical and process factors which will influence the risk of death

Question 2

Rivaroxaban when to stop and reversal

Answer 2

-Stop 48 hrs before major surgery
-Can be reversed with clotting factors such as beriplex/octaplex

Question 3

Clopidogrel perioperative management

Answer 3

-Hold 7 days prior to surgery electively (discuss with cardiology)
-No specific reversal agent
-Consider platelet transfusion in emergency operation if lots of bleeding expected
-Discuss with haematology

Question 4

Metallic heart valve

Answer 4

-Reverse warfarin
-Bridge with heparin
-Restart warfarin after surgery once safe to do so

Question 5

Warfarin

Answer 5

INR must be <1.5 for surgery