All EMS presentations
General MedicalClinical presentation

Post-operative concern

A streamlined, differential-led presentation for rapid clinical review.

Clinical snapshot

Twenty-second review

  • Post-operative symptoms may reflect expected inflammation or medication effects, but bleeding, infection, thromboembolism, ileus, respiratory compromise, and wound failure are important complications.
  • Shock, heavy wound or internal bleeding, dyspnea, chest pain, fever with organ dysfunction, peritonism, or new neurologic deficit is high risk.
  • Keep unrelated medical illness in the differential; overlapping or concurrent illness remains possible.
  • For post-operative concern, trends and combinations of findings are more informative than one isolated vital sign.
Differentials

Compare the clinical patterns

The repeated material is grouped inside each possibility. Open only the condition you need.

Serious4 conditions
HemorrhageTime-sensitive high-risk possibility

HPI

Clarify procedure and date; expected recovery instructions; pain, bleeding, fever or dyspnea.

Signs & symptoms

Worsening pain, bleeding, dyspnea, fever, shock, or peritonism.

Focused exam

Perform a targeted cardiorespiratory, neurologic, abdominal, skin, and hydration assessment guided by the history; Assess function against baseline rather than relying on a single normal-looking measurement.

Brief pathophysiology

Hemorrhage may cause post-operative concern through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

Hemorrhage is a trend diagnosis: tachycardia and narrowing pulse pressure may precede hypotension. Age, pregnancy, medications, and pacing can blunt expected responses.

Heart rate (bpm)

Often rises

Tachycardia is a common compensatory response but may be absent.

Pulse pressure (mmHg)

May narrow

Narrowing pulse pressure can reflect reduced stroke volume.

Blood pressure (mmHg)

May fall late

A normal pressure does not exclude significant compensated hemorrhage.

MAP (mmHg)

May fall

A falling trend supports worsening perfusion; interpret with mental status and skin signs.

Front-load in the triage report

  • Hemorrhage: Worsening pain, bleeding, dyspnea, fever, shock, or peritonism.
  • Procedure and date?
  • Expected recovery instructions?
SepsisTime-sensitive high-risk possibility

HPI

Clarify expected recovery instructions; pain, bleeding, fever or dyspnea; wound findings.

Signs & symptoms

Worsening pain, bleeding, dyspnea, fever, shock, or peritonism.

Focused exam

Assess function against baseline rather than relying on a single normal-looking measurement; Identify procedure and date, inspect wound and drains, assess lungs, abdomen, DVT signs, hydration, medications, bowel and urine function, and discharge instructions.

Brief pathophysiology

Sepsis may cause post-operative concern through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

No single vital sign diagnoses sepsis. New tachypnea, abnormal temperature, tachycardia, or falling pressure—especially with altered mentation or poor perfusion—supports organ dysfunction and urgency.

Respiratory rate (breaths/min)

May rise early

Tachypnea is included in NEWS2 and can precede overt hypotension.

Temperature (°C)

High or low

Absence of fever does not exclude sepsis; hypothermia is concerning.

Heart rate (bpm)

Often rises

Tachycardia is common but may be blunted by age or medication.

Blood pressure (mmHg)

May fall

Relative hypotension and trend matter; profound hypotension can be late.

Front-load in the triage report

  • Sepsis: Worsening pain, bleeding, dyspnea, fever, shock, or peritonism.
  • Expected recovery instructions?
  • Pain, bleeding, fever or dyspnea?
PETime-sensitive high-risk possibility

HPI

Clarify pain, bleeding, fever or dyspnea; wound findings; anticoagulants and antibiotics.

Signs & symptoms

Worsening pain, bleeding, dyspnea, fever, shock, or peritonism.

Focused exam

Assess function against baseline rather than relying on a single normal-looking measurement; Identify procedure and date, inspect wound and drains, assess lungs, abdomen, DVT signs, hydration, medications, bowel and urine function, and discharge instructions.

Brief pathophysiology

PE may cause post-operative concern through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

Pulmonary embolism may have normal observations. Tachycardia, tachypnea, or hypoxemia increase concern; hypotension identifies hemodynamic compromise rather than being required for diagnosis.

Heart rate (bpm)

May rise

Tachycardia is common but neither sensitive nor specific.

Respiratory rate (breaths/min)

May rise

Tachypnea may be an early sign of increased ventilatory demand.

Oxygen saturation (SpO₂)

May fall

Hypoxemia may occur, but a normal saturation does not exclude PE.

Blood pressure (mmHg)

Often preserved

Hypotension suggests high-risk PE with obstructive shock.

Front-load in the triage report

  • PE: Worsening pain, bleeding, dyspnea, fever, shock, or peritonism.
  • Pain, bleeding, fever or dyspnea?
  • Wound findings?
Anastomotic complicationTime-sensitive high-risk possibility

HPI

Clarify wound findings; anticoagulants and antibiotics; surgeon or facility advice.

Signs & symptoms

Worsening pain, bleeding, dyspnea, fever, shock, or peritonism.

Focused exam

Assess function against baseline rather than relying on a single normal-looking measurement; Identify procedure and date, inspect wound and drains, assess lungs, abdomen, DVT signs, hydration, medications, bowel and urine function, and discharge instructions.

Brief pathophysiology

Anastomotic complication may cause post-operative concern through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

General medical differentials have overlapping physiology. These four observations screen for deterioration and common reversible causes without implying a diagnosis.

Respiratory rate (breaths/min)

Trend rate / effort

Respiratory rate can reveal early physiologic stress.

Blood pressure (mmHg)

Compare with baseline

Relative hypotension may be important before an absolute threshold is crossed.

Heart rate (bpm)

Trend rate / rhythm

Interpret with hydration, perfusion, medications, and symptoms.

Blood glucose (mmol/L)

Check when indicated

Glucose disturbance can cause weakness or altered mentation.

Front-load in the triage report

  • Anastomotic complication: Worsening pain, bleeding, dyspnea, fever, shock, or peritonism.
  • Wound findings?
  • Anticoagulants and antibiotics?
Common2 conditions
Expected painCommon presentation pattern

HPI

Clarify procedure and date; expected recovery instructions; pain, bleeding, fever or dyspnea.

Signs & symptoms

Symptoms should follow the expected trajectory and respond to the prescribed plan.

Focused exam

Perform a targeted cardiorespiratory, neurologic, abdominal, skin, and hydration assessment guided by the history; Assess function against baseline rather than relying on a single normal-looking measurement.

Brief pathophysiology

Expected pain may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.

Vital-sign pattern

What the trend may show

Possible pattern

General medical differentials have overlapping physiology. These four observations screen for deterioration and common reversible causes without implying a diagnosis.

Respiratory rate (breaths/min)

Trend rate / effort

Respiratory rate can reveal early physiologic stress.

Blood pressure (mmHg)

Compare with baseline

Relative hypotension may be important before an absolute threshold is crossed.

Heart rate (bpm)

Trend rate / rhythm

Interpret with hydration, perfusion, medications, and symptoms.

Blood glucose (mmol/L)

Check when indicated

Glucose disturbance can cause weakness or altered mentation.

Front-load in the triage report

  • Symptoms should follow the expected trajectory and respond to the prescribed plan.
  • Procedure and date?
  • Expected recovery instructions?
Medication effectCommon presentation pattern

HPI

Clarify expected recovery instructions; pain, bleeding, fever or dyspnea; wound findings.

Signs & symptoms

Symptoms should follow the expected trajectory and respond to the prescribed plan.

Focused exam

Assess function against baseline rather than relying on a single normal-looking measurement; Identify procedure and date, inspect wound and drains, assess lungs, abdomen, DVT signs, hydration, medications, bowel and urine function, and discharge instructions.

Brief pathophysiology

Medication effect may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.

Vital-sign pattern

What the trend may show

Possible pattern

General medical differentials have overlapping physiology. These four observations screen for deterioration and common reversible causes without implying a diagnosis.

Respiratory rate (breaths/min)

Trend rate / effort

Respiratory rate can reveal early physiologic stress.

Blood pressure (mmHg)

Compare with baseline

Relative hypotension may be important before an absolute threshold is crossed.

Heart rate (bpm)

Trend rate / rhythm

Interpret with hydration, perfusion, medications, and symptoms.

Blood glucose (mmol/L)

Check when indicated

Glucose disturbance can cause weakness or altered mentation.

Front-load in the triage report

  • Symptoms should follow the expected trajectory and respond to the prescribed plan.
  • Expected recovery instructions?
  • Pain, bleeding, fever or dyspnea?
Mimics1 condition
Unrelated medical illnessImportant alternative presentation

HPI

Clarify procedure and date; expected recovery instructions; pain, bleeding, fever or dyspnea.

Signs & symptoms

New symptoms may not be surgical complications.

Focused exam

Perform a targeted cardiorespiratory, neurologic, abdominal, skin, and hydration assessment guided by the history; Assess function against baseline rather than relying on a single normal-looking measurement.

Brief pathophysiology

Unrelated medical illness can resemble post-operative concern through overlapping symptoms or referred physiology despite a different primary mechanism.

Vital-sign pattern

What the trend may show

Possible pattern

General medical differentials have overlapping physiology. These four observations screen for deterioration and common reversible causes without implying a diagnosis.

Respiratory rate (breaths/min)

Trend rate / effort

Respiratory rate can reveal early physiologic stress.

Blood pressure (mmHg)

Compare with baseline

Relative hypotension may be important before an absolute threshold is crossed.

Heart rate (bpm)

Trend rate / rhythm

Interpret with hydration, perfusion, medications, and symptoms.

Blood glucose (mmol/L)

Check when indicated

Glucose disturbance can cause weakness or altered mentation.

Front-load in the triage report

  • New symptoms may not be surgical complications.
  • Procedure and date?
  • Expected recovery instructions?
Red flags

Findings that should escalate concern

  • Shock, heavy wound or internal bleeding, dyspnea, chest pain, fever with organ dysfunction, peritonism, or new neurologic deficit is high risk.
  • Hemorrhage, sepsis, PE, or anastomotic complication: Worsening pain, bleeding, dyspnea, fever, shock, or peritonism.
Related medications

Medication recognition

AmoxicillinApixabanRivaroxabanClopidogrelCephalexinWarfarin
Related EMS presentations

Continue the clinical pathway

GIAbdominal painRespiratoryPleuritic chest painInfectiousSuspected sepsisHematologicBleeding while anticoagulatedGeneral MedicalMedical device / line problem
References

Clinical and academic sources

Curated clinical guidance and peer-reviewed evidence supporting this presentation. Current BCEHS guidance, medical direction, and local policy remain authoritative for practice.

BCEHS Handbook — specific CPGs

  1. A02: Patient AssessmentBC Emergency Health Services Handbook

    Official BCEHS clinical practice guidance for patient assessment.

Supporting clinical and academic evidence

  1. CEDIS Presenting Complaint List updateCanadian Association of Emergency Physicians

    Presenting-complaint terminology and categorization context. It does not establish a prehospital “top 100” ranking.

  2. WHO Medical Emergency ChecklistWorld Health Organization

    A structured emergency assessment framework intended to reduce missed life-threatening conditions.

  3. Coronary artery bypass graft surgery complications: a review for emergency cliniciansAmerican Journal of Emergency Medicine · 2018

    A structured model for recognizing time-sensitive bleeding, infection, cardiopulmonary, and wound complications after surgery.