S — Situation
“Hello, it’s David, the SHO on Ward 4G. I’m calling about Mrs Eleanor Thompson, DOB 15/06/1942, who is post-operative day 2 following a right mastectomy with axillary lymph node clearance.
She has developed new right axillary swelling, discomfort, and mild shortness of breath, and I’m concerned about a possible early postoperative complication.”
B — Background
“She has moderate COPD, mild left ventricular failure, and hypertension.
Her surgery two days ago was uneventful with 150 mL blood loss, and a drain was inserted.
Since yesterday, her temperature has been slowly rising from 36.9 to 37.2 today.
Importantly, the drain has had no output today, and the axilla appears swollen and mildly tender.
Her daughter is requesting discharge today due to family childcare pressures, but given the clinical changes I feel this is unsafe.”
A — Assessment
“On examination, she has a swollen right axilla, mild tenderness, and no drain output. Her pain is controlled, and observations are otherwise stable apart from very mild temperature rise.
Her bloods today show: WCC 10.2, Hb 11.5, platelets 230.
My concern is a postoperative seroma, haematoma, or possibly early infection, or a blocked drain.
Given her comorbidities and mild SOB, I also want to rule out cardiopulmonary causes.”
R — Recommendation
“I’d like you to review her urgently, please.
I’d appreciate guidance on whether to:
Attempt drainage (needle aspiration) or re-site/flush the drain,
Start empirical antibiotics,
Arrange ultrasound of the axilla,
And confirm whether you agree she should not be discharged today.
Could you please come to review her on Ward 4G, or advise on the next immediate steps?”
