This document discusses postoperative management of surgical patients. It describes the different levels of postoperative care including same-day surgery, the surgical floor, telemetry ward, and intensive care unit. Factors determining a patient's disposition include their preoperative health, procedure performed, and postoperative clinical status. The document also discusses common postoperative orders related to tubes, drains, oxygen therapy, and wound care to guide nursing staff.
The document discusses the approach to a patient experiencing ongoing bleeding. It outlines the following key steps:
1. First consider the possibility of a technical cause like an unligated vessel and examine for injuries.
2. If no technical cause is found, check the patient's temperature and perform laboratory tests. Hypothermia can cause coagulopathy.
3. Evaluate test results along with the patient's history for clues to underlying causes like platelet dysfunction, coagulation factor deficiencies, or inherited bleeding disorders. Treat the specific condition while continuing evaluation.
This document summarizes an article about volunteer surgeons providing care to wounded soldiers in Iraq and Afghanistan. It discusses the senior visiting surgeon program established by the American College of Surgeons that allows surgeons to volunteer their time. The volunteer rotation described involved caring for patients at Landstuhl Regional Medical Center in Germany as part of the complex medical evacuation process bringing wounded soldiers from war zones to the United States for further treatment and recovery.
A C S0103 Perioperative Considerations For Anesthesiamedbookonline
This document discusses perioperative considerations for anesthesia. It notes advancements in modern surgical care and alterations in anesthetic management to maximize patient benefit. A preoperative evaluation is important to assess medical history and current medications. Certain medications may need to be adjusted or discontinued before surgery, such as MAOIs, oral anticoagulants, and some herbal supplements, to reduce risks of adverse reactions or bleeding complications during the procedure. The risks and options for anesthesia should be discussed with the patient.
This document summarizes key points about surgical treatment of early rectal cancer and care of elderly surgical patients. It discusses that radical resection for early rectal cancer achieves excellent local control but has risks, while local excision may be preferable but has a higher local recurrence rate. Adjuvant therapy after local excision may help address this. It also notes that the elderly population is growing and physiologic changes with aging, like cardiac function decline, must be considered in surgical planning and risk assessment for elderly patients. Functional status is more important than age alone.
This document provides guidelines for myocardial perfusion imaging (MPI), including:
1. MPI utilizes radiopharmaceuticals and imaging techniques to identify areas of reduced blood flow in the heart associated with ischemia or scar.
2. Common indications for MPI are to assess for presence, location, and severity of perfusion abnormalities; determine significance of angiographic findings; and detect viable ischemic myocardium.
3. Common clinical settings are for known or suspected coronary artery disease, follow-up of patients with known CAD, and evaluation of congestive heart failure.
1. This study compared general anesthesia (GA) and spinal anesthesia (SA) for 100 patients undergoing lumbar disk surgery through a randomized controlled trial.
2. Intraoperatively, mean blood loss was less with GA but not significantly. Surgeon satisfaction was higher with GA. No major complications occurred with either.
3. Postoperatively, hypertension was more common after GA, and nausea/vomiting were more frequent after SA.
4. Contrary to previous studies, the findings revealed SA had no advantages over GA, and GA may reduce risks and complications.
06 acute coronary syndromes is there a place for a real pre hospital treatmen...NPSAIC
1) The management of acute coronary syndrome (ACS) patients requires close collaboration between emergency physicians and cardiologists according to simplified protocols.
2) Key challenges for pre-hospital ACS management include precise knowledge of new drugs, developing regional hospital cooperation, organizing the healthcare network, and regularly analyzing practices.
3) The emergency physician must adapt strategies to international guidelines and the patient's needs, routing high-risk patients directly to catheterization facilities within recommended time limits.
1. The document discusses various sources of data for benchmarking surgical outcomes, including public reporting programs, public use administrative databases, and clinical registries. It notes limitations of using administrative data including problems with accuracy, completeness, and clinical precision of coding.
2. Clinical registries like the National Surgical Quality Improvement Program (NSQIP) and the Society of Thoracic Surgeons database are described as better sources of benchmarking data as they provide risk-adjusted outcomes while protecting individual hospital and surgeon confidentiality.
3. Limitations of all surgical benchmarking sources include small sample sizes, lack of generalizability between databases, and lack of external auditing to ensure accuracy and completeness of submitted data.
The document discusses the approach to a patient experiencing ongoing bleeding. It outlines the following key steps:
1. First consider the possibility of a technical cause like an unligated vessel and examine for injuries.
2. If no technical cause is found, check the patient's temperature and perform laboratory tests. Hypothermia can cause coagulopathy.
3. Evaluate test results along with the patient's history for clues to underlying causes like platelet dysfunction, coagulation factor deficiencies, or inherited bleeding disorders. Treat the specific condition while continuing evaluation.
This document summarizes an article about volunteer surgeons providing care to wounded soldiers in Iraq and Afghanistan. It discusses the senior visiting surgeon program established by the American College of Surgeons that allows surgeons to volunteer their time. The volunteer rotation described involved caring for patients at Landstuhl Regional Medical Center in Germany as part of the complex medical evacuation process bringing wounded soldiers from war zones to the United States for further treatment and recovery.
A C S0103 Perioperative Considerations For Anesthesiamedbookonline
This document discusses perioperative considerations for anesthesia. It notes advancements in modern surgical care and alterations in anesthetic management to maximize patient benefit. A preoperative evaluation is important to assess medical history and current medications. Certain medications may need to be adjusted or discontinued before surgery, such as MAOIs, oral anticoagulants, and some herbal supplements, to reduce risks of adverse reactions or bleeding complications during the procedure. The risks and options for anesthesia should be discussed with the patient.
This document summarizes key points about surgical treatment of early rectal cancer and care of elderly surgical patients. It discusses that radical resection for early rectal cancer achieves excellent local control but has risks, while local excision may be preferable but has a higher local recurrence rate. Adjuvant therapy after local excision may help address this. It also notes that the elderly population is growing and physiologic changes with aging, like cardiac function decline, must be considered in surgical planning and risk assessment for elderly patients. Functional status is more important than age alone.
This document provides guidelines for myocardial perfusion imaging (MPI), including:
1. MPI utilizes radiopharmaceuticals and imaging techniques to identify areas of reduced blood flow in the heart associated with ischemia or scar.
2. Common indications for MPI are to assess for presence, location, and severity of perfusion abnormalities; determine significance of angiographic findings; and detect viable ischemic myocardium.
3. Common clinical settings are for known or suspected coronary artery disease, follow-up of patients with known CAD, and evaluation of congestive heart failure.
1. This study compared general anesthesia (GA) and spinal anesthesia (SA) for 100 patients undergoing lumbar disk surgery through a randomized controlled trial.
2. Intraoperatively, mean blood loss was less with GA but not significantly. Surgeon satisfaction was higher with GA. No major complications occurred with either.
3. Postoperatively, hypertension was more common after GA, and nausea/vomiting were more frequent after SA.
4. Contrary to previous studies, the findings revealed SA had no advantages over GA, and GA may reduce risks and complications.
06 acute coronary syndromes is there a place for a real pre hospital treatmen...NPSAIC
1) The management of acute coronary syndrome (ACS) patients requires close collaboration between emergency physicians and cardiologists according to simplified protocols.
2) Key challenges for pre-hospital ACS management include precise knowledge of new drugs, developing regional hospital cooperation, organizing the healthcare network, and regularly analyzing practices.
3) The emergency physician must adapt strategies to international guidelines and the patient's needs, routing high-risk patients directly to catheterization facilities within recommended time limits.
1. The document discusses various sources of data for benchmarking surgical outcomes, including public reporting programs, public use administrative databases, and clinical registries. It notes limitations of using administrative data including problems with accuracy, completeness, and clinical precision of coding.
2. Clinical registries like the National Surgical Quality Improvement Program (NSQIP) and the Society of Thoracic Surgeons database are described as better sources of benchmarking data as they provide risk-adjusted outcomes while protecting individual hospital and surgeon confidentiality.
3. Limitations of all surgical benchmarking sources include small sample sizes, lack of generalizability between databases, and lack of external auditing to ensure accuracy and completeness of submitted data.
[TRAUMATOLOGY] SOFT TISSUE MANAGEMENT AND RECONSTRUCTION IN ORTHOPAEDICS EMER...Bethwell Radiro
1. Open fractures involve damage to both the bone and surrounding soft tissues, while closed fractures only involve bone damage.
2. Early accurate debridement of traumatic wounds within 24 hours is the most important procedure for managing open lower limb fractures. This involves excising all devitalized tissue.
3. Antibiotics should be administered as soon as possible and surgical debridement and skeletal stabilization is typically performed by orthopaedic and plastic surgeons together within 24 hours, unless there is significant contamination.
This study evaluated the effect of heparin on the patency of arteriovenous fistulas in 198 patients undergoing surgery for hemodialysis access. Patients were randomly assigned to receive either intraoperative intravenous heparin (n=96) or no heparin (n=102). Early patency rates were similar between groups, but at 2 weeks follow up, the patency rate was higher in the heparin group (85%) compared to the control group (74%), a statistically significant difference. The study concludes that intraoperative heparin administration improves short-term arteriovenous fistula patency.
This document summarizes guidelines for thromboprophylaxis from the 7th ACCP conference. It discusses the rationale for thromboprophylaxis, including the high prevalence and adverse consequences of unprevented VTE. It outlines risk factors for VTE and basic principles of thromboprophylaxis. It provides recommendations for prophylaxis in different patient groups based on risk level, including for different surgical procedures. It discusses strategies to improve implementation of guidelines in clinical practice.
This document discusses penetrating injuries and management approaches. It provides information on:
1) Factors that determine energy transfer from penetrating weapons including weapon type, range, and tissue properties. Vital structures like brain and liver are more susceptible to injury.
2) Options for managing penetrating torso trauma have expanded from routinely operating to include selective non-operative approaches with monitoring.
3) Indications for emergency thoracotomy or laparotomy include hemodynamic instability, peritonitis on exam, or unexpected drops in vitals or hematocrit. Triple-contrast CT can help determine need for surgery.
This study analyzed early postoperative complications in 145 adult patients who received total intravenous anesthesia (TIVA) with propofol and remifentanil for elective neurosurgery. The authors found:
1) The overall incidence of shivering was 30.3%, postoperative nausea and vomiting (PONV) was 16.6%, and postoperative hypertension (blood pressure over 25% of preoperative value) was 35.2%.
2) 51% of patients experienced at least one of these complications. Complication rates varied significantly between surgical groups.
3) The intracranial vascular surgery group had the highest rates of shivering (58.8%) and PONV (29.4
The document discusses the care of surgical patients from pre-operation through recovery. It covers preparing the patient physically and psychologically for surgery, different types of surgeries and anesthesia, and the roles and responsibilities of staff in caring for surgical patients before, during, and after a procedure. Common patient fears are also addressed.
This document provides an introduction to guidelines for the surgical management of traumatic brain injury (TBI). TBI affects up to 2% of the population per year and is a major cause of death and disability, especially in young people. Intracranial hematomas complicate 25-45% of severe TBI cases and are the most important complication, as they can transform an otherwise mild injury into death or permanent disability if not treated effectively and promptly. The guidelines were created by a group of neurosurgeons to provide evidence-based recommendations for surgical management of post-traumatic intracranial mass lesions based on a review of over 700 publications from 1975-2001. However, there are no controlled clinical trials, so recommendations
This study aimed to determine if preoperative hematological parameters and risk factors could predict in-hospital mortality for patients undergoing surgery to repair Type A aortic dissection. The study reviewed data from 78 patients who underwent deep hypothermic circulatory arrest surgery. Only preoperative creatinine levels were higher in patients who died. Total circulatory arrest time and cross-clamp time during surgery were found to be factors affecting mortality, with times over 44.5 minutes and 71 minutes respectively predicting higher risk of death. The study concluded that hematological biomarkers alone may be insufficient for estimating mortality risk, and intraoperative factors like longer circulatory arrest and clamp times impact outcomes for Type A aortic dissection surgery.
1) The document discusses the management of pregnant patients requiring surgery or experiencing trauma. It notes special considerations for pregnant patients, including physiological changes and the need to care for both mother and fetus.
2) In trauma situations, the initial focus is stabilizing the mother to benefit both patients. Penetrating injuries often directly threaten the fetus while blunt trauma poses less direct risk, usually resulting in placental abruption or preterm labor.
3) Surgical decisions must weigh fetal viability against maternal stability, with non-urgent cases delayed if possible. Monitoring includes fetal heart monitoring and ultrasound to detect issues like abruption.
This document provides information on parotidectomy surgery and the Fundamentals of Laparoscopic Surgery (FLS) program.
It describes the technique for parotidectomy surgery, including identifying and dissecting around the facial nerve. It notes that most parotid tumors are benign and complications are usually temporary facial nerve paralysis.
It then discusses the development of the FLS program to standardize laparoscopic surgery training. The program includes cognitive training and manual skills assessment. Many residency programs and hospitals now require surgeons to complete the FLS. A large grant will help make the program more accessible to residency programs.
This document discusses perioperative nursing. It covers the three phases of perioperative care: preoperative, intraoperative, and postoperative. It describes goals and assessments for the preoperative phase, including physiologic and psychologic evaluation of the patient and providing education. Surgical procedures are classified based on purpose, urgency, degree of risk, and whether they are performed as ambulatory/same-day surgery. Risks and the patient's fears and concerns are addressed. Informed consent is also discussed.
Previsioni e meccanismi di fallimento oncologico in seguito a chirurgia conse...MerqurioEditore_redazione
1) Thirteen of 229 patients (5.6%) who underwent nephron-sparing surgery for renal cancer experienced tumor recurrence during an average follow-up of 45 months.
2) Mechanisms of recurrence included distant metastases, seeding during surgery, residual disease, and new tumor growth.
3) Predictors of oncological failure were large central tumor size, long warm ischemia time during surgery, and the presence of multiple tumors.
This study evaluated the diagnostic accuracy of CT scans for detecting injuries in 100 patients with blunt abdominal trauma. CT scans had high sensitivity for liver (100%) and spleen (86.6%) injuries. Specificity was highest for retroperitoneal hematoma (100%) and kidney injuries (93.5%). The accuracy of CT scans for detecting injuries to spleen, liver, kidney, and retroperitoneal hematoma ranged from 91.6% to 96.1%. The study concluded that CT scans are a good tool for evaluating blunt abdominal trauma in teaching hospitals.
This document discusses perioperative care and defines the three phases as preoperative, intraoperative, and postoperative. It outlines nursing responsibilities and goals in each phase, including assessment, monitoring for complications, education, and promoting patient well-being and recovery.
In hospital complications after total joint arthroplastyFUAD HAZIME
The study prospectively collected data on systemic and local complications from 15,383 joint arthroplasty procedures performed over 6 years. There were 486 major systemic complications, most commonly pulmonary embolism (152 cases), tachyarrhythmia (92), and acute myocardial infarction (36). There were also 109 major local complications, including 16 vascular injuries and 29 peripheral nerve injuries. The incidence of complications was higher after knee arthroplasty, bilateral procedures, and revision surgery. This study provides baseline data on the range and frequency of potential in-hospital complications following elective joint arthroplasty.
HRV in trauma patients during prehospital transportRachel Russo, MD
1) The study found that prehospital heart rate variability (HRV), specifically standard deviation of normal-to-normal R-R intervals (SDNN), predicted patients with a base excess ≤-6, those requiring life-saving procedures, and those classified as seriously injured better than routine trauma criteria or vital signs.
2) When used alone as a triage tool, SDNN had a sensitivity of 80%, specificity of 75%, and accuracy of 76% for predicting life-saving interventions, outperforming other prehospital measures.
3) Incorporating SDNN into trauma triage criteria models improved prediction of outcomes compared to models without SDNN, better discriminating patients who were seriously or minimally injured
The document provides an overview of perioperative nursing care. It discusses the three phases of surgery: preoperative, intraoperative, and postoperative. In the preoperative phase, the nurse conducts assessments, provides education to the client, and ensures informed consent is obtained. During surgery, nurses manage risks and ensure proper technique is maintained. In post-op, nurses monitor for complications and promote recovery. Perioperative nursing aims to provide excellent care before, during, and after surgery by addressing clients' physical and psychosocial needs.
The document provides guidelines for the perioperative management of patients with obstructive sleep apnea (OSA). It defines OSA and discusses its prevalence. The guidelines were developed through a rigorous process including a literature review and input from experts. The guidelines aim to improve perioperative care and reduce risks for patients with OSA undergoing procedures. Recommendations are made regarding preoperative assessment and risk stratification of patients, as well as postoperative monitoring and care.
This document provides an overview of a medical surgical nursing course, including learning outcomes, assignments, grading, and textbook recommendations. It then provides a detailed overview of the main lecture on perioperative concepts and nursing management. The main lecture covers preoperative, intraoperative, and postoperative nursing care including patient assessment, classifications of surgical procedures, preoperative teaching, and the surgical phases.
This document provides an overview of indications for admission to an intensive care unit (ICU). It discusses the types of ICUs, including open and closed units, and specialty units organized by patient type. The functions of the ICU are described, including invasive and non-invasive monitoring, hemodynamic support, ventilation, nutrition, and treatment of the underlying illness. Admission criteria include those needing advanced respiratory, circulatory, neurological, or renal support. Equipment used in ICUs is also reviewed.
[TRAUMATOLOGY] SOFT TISSUE MANAGEMENT AND RECONSTRUCTION IN ORTHOPAEDICS EMER...Bethwell Radiro
1. Open fractures involve damage to both the bone and surrounding soft tissues, while closed fractures only involve bone damage.
2. Early accurate debridement of traumatic wounds within 24 hours is the most important procedure for managing open lower limb fractures. This involves excising all devitalized tissue.
3. Antibiotics should be administered as soon as possible and surgical debridement and skeletal stabilization is typically performed by orthopaedic and plastic surgeons together within 24 hours, unless there is significant contamination.
This study evaluated the effect of heparin on the patency of arteriovenous fistulas in 198 patients undergoing surgery for hemodialysis access. Patients were randomly assigned to receive either intraoperative intravenous heparin (n=96) or no heparin (n=102). Early patency rates were similar between groups, but at 2 weeks follow up, the patency rate was higher in the heparin group (85%) compared to the control group (74%), a statistically significant difference. The study concludes that intraoperative heparin administration improves short-term arteriovenous fistula patency.
This document summarizes guidelines for thromboprophylaxis from the 7th ACCP conference. It discusses the rationale for thromboprophylaxis, including the high prevalence and adverse consequences of unprevented VTE. It outlines risk factors for VTE and basic principles of thromboprophylaxis. It provides recommendations for prophylaxis in different patient groups based on risk level, including for different surgical procedures. It discusses strategies to improve implementation of guidelines in clinical practice.
This document discusses penetrating injuries and management approaches. It provides information on:
1) Factors that determine energy transfer from penetrating weapons including weapon type, range, and tissue properties. Vital structures like brain and liver are more susceptible to injury.
2) Options for managing penetrating torso trauma have expanded from routinely operating to include selective non-operative approaches with monitoring.
3) Indications for emergency thoracotomy or laparotomy include hemodynamic instability, peritonitis on exam, or unexpected drops in vitals or hematocrit. Triple-contrast CT can help determine need for surgery.
This study analyzed early postoperative complications in 145 adult patients who received total intravenous anesthesia (TIVA) with propofol and remifentanil for elective neurosurgery. The authors found:
1) The overall incidence of shivering was 30.3%, postoperative nausea and vomiting (PONV) was 16.6%, and postoperative hypertension (blood pressure over 25% of preoperative value) was 35.2%.
2) 51% of patients experienced at least one of these complications. Complication rates varied significantly between surgical groups.
3) The intracranial vascular surgery group had the highest rates of shivering (58.8%) and PONV (29.4
The document discusses the care of surgical patients from pre-operation through recovery. It covers preparing the patient physically and psychologically for surgery, different types of surgeries and anesthesia, and the roles and responsibilities of staff in caring for surgical patients before, during, and after a procedure. Common patient fears are also addressed.
This document provides an introduction to guidelines for the surgical management of traumatic brain injury (TBI). TBI affects up to 2% of the population per year and is a major cause of death and disability, especially in young people. Intracranial hematomas complicate 25-45% of severe TBI cases and are the most important complication, as they can transform an otherwise mild injury into death or permanent disability if not treated effectively and promptly. The guidelines were created by a group of neurosurgeons to provide evidence-based recommendations for surgical management of post-traumatic intracranial mass lesions based on a review of over 700 publications from 1975-2001. However, there are no controlled clinical trials, so recommendations
This study aimed to determine if preoperative hematological parameters and risk factors could predict in-hospital mortality for patients undergoing surgery to repair Type A aortic dissection. The study reviewed data from 78 patients who underwent deep hypothermic circulatory arrest surgery. Only preoperative creatinine levels were higher in patients who died. Total circulatory arrest time and cross-clamp time during surgery were found to be factors affecting mortality, with times over 44.5 minutes and 71 minutes respectively predicting higher risk of death. The study concluded that hematological biomarkers alone may be insufficient for estimating mortality risk, and intraoperative factors like longer circulatory arrest and clamp times impact outcomes for Type A aortic dissection surgery.
1) The document discusses the management of pregnant patients requiring surgery or experiencing trauma. It notes special considerations for pregnant patients, including physiological changes and the need to care for both mother and fetus.
2) In trauma situations, the initial focus is stabilizing the mother to benefit both patients. Penetrating injuries often directly threaten the fetus while blunt trauma poses less direct risk, usually resulting in placental abruption or preterm labor.
3) Surgical decisions must weigh fetal viability against maternal stability, with non-urgent cases delayed if possible. Monitoring includes fetal heart monitoring and ultrasound to detect issues like abruption.
This document provides information on parotidectomy surgery and the Fundamentals of Laparoscopic Surgery (FLS) program.
It describes the technique for parotidectomy surgery, including identifying and dissecting around the facial nerve. It notes that most parotid tumors are benign and complications are usually temporary facial nerve paralysis.
It then discusses the development of the FLS program to standardize laparoscopic surgery training. The program includes cognitive training and manual skills assessment. Many residency programs and hospitals now require surgeons to complete the FLS. A large grant will help make the program more accessible to residency programs.
This document discusses perioperative nursing. It covers the three phases of perioperative care: preoperative, intraoperative, and postoperative. It describes goals and assessments for the preoperative phase, including physiologic and psychologic evaluation of the patient and providing education. Surgical procedures are classified based on purpose, urgency, degree of risk, and whether they are performed as ambulatory/same-day surgery. Risks and the patient's fears and concerns are addressed. Informed consent is also discussed.
Previsioni e meccanismi di fallimento oncologico in seguito a chirurgia conse...MerqurioEditore_redazione
1) Thirteen of 229 patients (5.6%) who underwent nephron-sparing surgery for renal cancer experienced tumor recurrence during an average follow-up of 45 months.
2) Mechanisms of recurrence included distant metastases, seeding during surgery, residual disease, and new tumor growth.
3) Predictors of oncological failure were large central tumor size, long warm ischemia time during surgery, and the presence of multiple tumors.
This study evaluated the diagnostic accuracy of CT scans for detecting injuries in 100 patients with blunt abdominal trauma. CT scans had high sensitivity for liver (100%) and spleen (86.6%) injuries. Specificity was highest for retroperitoneal hematoma (100%) and kidney injuries (93.5%). The accuracy of CT scans for detecting injuries to spleen, liver, kidney, and retroperitoneal hematoma ranged from 91.6% to 96.1%. The study concluded that CT scans are a good tool for evaluating blunt abdominal trauma in teaching hospitals.
This document discusses perioperative care and defines the three phases as preoperative, intraoperative, and postoperative. It outlines nursing responsibilities and goals in each phase, including assessment, monitoring for complications, education, and promoting patient well-being and recovery.
In hospital complications after total joint arthroplastyFUAD HAZIME
The study prospectively collected data on systemic and local complications from 15,383 joint arthroplasty procedures performed over 6 years. There were 486 major systemic complications, most commonly pulmonary embolism (152 cases), tachyarrhythmia (92), and acute myocardial infarction (36). There were also 109 major local complications, including 16 vascular injuries and 29 peripheral nerve injuries. The incidence of complications was higher after knee arthroplasty, bilateral procedures, and revision surgery. This study provides baseline data on the range and frequency of potential in-hospital complications following elective joint arthroplasty.
HRV in trauma patients during prehospital transportRachel Russo, MD
1) The study found that prehospital heart rate variability (HRV), specifically standard deviation of normal-to-normal R-R intervals (SDNN), predicted patients with a base excess ≤-6, those requiring life-saving procedures, and those classified as seriously injured better than routine trauma criteria or vital signs.
2) When used alone as a triage tool, SDNN had a sensitivity of 80%, specificity of 75%, and accuracy of 76% for predicting life-saving interventions, outperforming other prehospital measures.
3) Incorporating SDNN into trauma triage criteria models improved prediction of outcomes compared to models without SDNN, better discriminating patients who were seriously or minimally injured
The document provides an overview of perioperative nursing care. It discusses the three phases of surgery: preoperative, intraoperative, and postoperative. In the preoperative phase, the nurse conducts assessments, provides education to the client, and ensures informed consent is obtained. During surgery, nurses manage risks and ensure proper technique is maintained. In post-op, nurses monitor for complications and promote recovery. Perioperative nursing aims to provide excellent care before, during, and after surgery by addressing clients' physical and psychosocial needs.
The document provides guidelines for the perioperative management of patients with obstructive sleep apnea (OSA). It defines OSA and discusses its prevalence. The guidelines were developed through a rigorous process including a literature review and input from experts. The guidelines aim to improve perioperative care and reduce risks for patients with OSA undergoing procedures. Recommendations are made regarding preoperative assessment and risk stratification of patients, as well as postoperative monitoring and care.
This document provides an overview of a medical surgical nursing course, including learning outcomes, assignments, grading, and textbook recommendations. It then provides a detailed overview of the main lecture on perioperative concepts and nursing management. The main lecture covers preoperative, intraoperative, and postoperative nursing care including patient assessment, classifications of surgical procedures, preoperative teaching, and the surgical phases.
This document provides an overview of indications for admission to an intensive care unit (ICU). It discusses the types of ICUs, including open and closed units, and specialty units organized by patient type. The functions of the ICU are described, including invasive and non-invasive monitoring, hemodynamic support, ventilation, nutrition, and treatment of the underlying illness. Admission criteria include those needing advanced respiratory, circulatory, neurological, or renal support. Equipment used in ICUs is also reviewed.
Day surgery, also known as ambulatory surgery, involves performing surgical procedures on patients who are admitted and discharged within 12 hours without an overnight hospital stay. Day surgery offers advantages for both patients and healthcare systems by reducing disruption to patients' lives and providing significant cost savings. A variety of medical, social, and surgical criteria are used to determine patient eligibility for day surgery to minimize risks and ensure safe recovery at home. Successful day surgery requires thorough preoperative patient assessment, optimized anesthesia and postoperative pain management, and monitoring to prevent complications.
This document outlines principles of intensive care unit (ICU) care for surgical patients. It discusses admission criteria including pre-operative risk factors and post-operative need for monitoring or organ support. Models of ICU organization and levels of care are described. Key aspects of ICU care are monitoring of vital signs and organ function, specific medical or surgical treatments tailored to individual patients, and providing system support like respiratory support. Family meetings are important for communication and shared decision making. The document provides guidance on appropriate ICU triage and exclusions to optimize resource utilization for critically ill surgical patients.
Day surgery offers advantages for both patients and healthcare providers by reducing disruption and costs compared to overnight stays. Success requires efficient coordination across admission, the procedure itself, recovery, and safe discharge within 12 hours. Selection criteria evaluate medical fitness, social support, and whether the planned procedure is suitable for day surgery. Preoperative assessment optimizes patient health while clear discharge standards ensure recovery before leaving. Common day surgery procedures involve areas like abdominal, breast, orthopedic, and vascular operations. Emergency minor cases can also sometimes be managed with same-day admission and discharge.
This document summarizes guidelines for oxygen therapy in post-operative care. It recommends that oxygen therapy is an important part of recovery and can reduce post-operative complications. The summary outlines standards for best practice, such as all patients in recovery receiving oxygen according to local guidelines, and all high-risk patients who could benefit from post-operative oxygen being prescribed it and using it correctly. Audit indicators are proposed to measure adherence to these standards.
This document discusses fast-track cardiac surgery protocols. It begins by defining fast-track surgery as rapidly progressing a patient from preoperative preparation through surgery and discharge from the hospital. It then mentions that fast-tracking requires a coordinated team approach. Several studies are referenced that show fast-tracking leads to shorter ICU and hospital stays without increasing complications when used for appropriately selected low-risk patients. Key elements of fast-tracking include enhanced patient education, same-day admissions, early extubation and mobilization, aggressive pulmonary care, and early discharge. Extubation in the operating room rather than ICU is associated with lower reintubation rates. The document concludes that fast-tracking cardiac surgery is safe and effective for reducing costs when applied to
Here are the triage categories I would assign to each patient based on the information provided:
1. 30 year old male with a compound fracture of left femur, bleeding significantly. Resp. rate 24. Cap. refill less than 2 sec. Alert and oriented.
Category: DELAYED
2. 44 year old male sitting up with chest pain without obvious injury. Resp. rate 24. Cap. refill less than 2 sec. Alert and oriented.
Category: DELAYED
3. 28 year old female with fracture of left wrist. Resp. rate 22. Cap. refill less than 2 sec. Alert and oriented. Decides she can walk after all.
Category: MINOR
The document discusses admission and discharge policies and procedures for intensive care units (ICUs). It defines ICUs and other critical care levels. Admission depends on likelihood of benefit from intensive care and availability of beds. Scoring systems like APACHE II are used to predict outcomes but not for individual patients. Discharge occurs when intensive care is no longer needed or further treatment is deemed futile. Senior staff involvement, documentation, and family agreement are important for difficult discharge decisions.
Day case surgery, also known as ambulatory surgery, involves planned admission and discharge of a patient within 12 hours for a surgical procedure. It provides several benefits over traditional inpatient surgery such as shorter hospital stays, lower infection rates, and more efficient use of healthcare resources. Common procedures performed as day cases include hernia repairs, cataract removal, and tonsillectomies. Careful patient selection and optimization, as well as coordinated perioperative management involving preoperative assessment and education, regional anesthesia when possible, early mobilization and feeding, and established discharge criteria are important for success. Day case surgery allows for treatment of more patients while maintaining high quality care.
2018 ATLS PROTOCOL
FOCUSING ON THE PRIMORDIAL MANAGEMENT OF PT IN THE APPROACH OF IMPROVING TRAUMA PT MANAGEMENT AND REDUCING MORTALITY OF TRAUMA PT AT OUR RESPECTIVE HEALTH FACILITIES AS DOCTORS AND CLINICIANS WORKING IN THE EMERGENCY DEPARTMENT.
GIVEN THE NECESSARY EQUIPMENT AND FAVOURABLE AMBIENT WORKING ENVIRONMENT WE SHOULD BE ABLE TO OFFER OUR HUMANITY RACE QUALITY SERVICES BEARING IN MIND THAT LIFE COME FIRST AND ALL THE OTHER ATTRIBUTES IN LIFE FOLLOWS
1. This document provides guidelines for day case and short stay surgery from a working party established by the Association of Anaesthetists of Great Britain and Ireland and the British Association of Day Surgery.
2. Effective pre-operative preparation and protocol-driven, nurse-led discharge are fundamental to safe and effective day and short stay surgery.
3. Selection of patients for day surgery considers social factors like having a caregiver at home, medical factors like fitness and stability of chronic conditions, and surgical factors like risk of complications requiring immediate medical attention.
Peri-operative Nursing/Anesthesia/Pain ManagementWasim Ak
The care provide during surgical intervention (pre-operative, intra-operative and post-operative period) is known as Peri-operative Nursing Care.
Peri-operative Nursing Care includes :
Pre-operative Nursing Care
Intra-operative Nursing Care
Post-operative Nursing Care.
Anesthesia means “loss of sensation with or without loss of consciousness” .
Medications that cause anaesthesia, are called Anesthetics.
Anesthesia is defined as a temporary state consisting of unconsciousness, loss of memory, lack of pain, and muscle relaxation.
Anesthesia is defined as a loss of feeling or awareness caused by drugs or other substances which keeps patient free from feeling pain during surgery or other procedures.
This document provides an overview of the history and definitions of ambulatory surgery. Key points include:
- Ambulatory surgery is defined as surgery where the patient is discharged on the same working day, in contrast to inpatient surgery where patients stay overnight.
- Ambulatory surgery became common in the 1970s-1980s in developed countries, where now 50-70% of surgeries are done on an ambulatory basis.
- Ambulatory surgery provides benefits in terms of safety, quality, economics, and staff satisfaction compared to traditional inpatient surgery models. When proper standards of care are followed, ambulatory surgery has been shown to be as safe as inpatient surgery.
Surgery Resident clinical seminar on day case surgery presented to the department of surgery, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State
Acs0109 Fast Track Inpatient And Ambulatory Surgerymedbookonline
Fast track surgery aims to reduce complications, facilitate earlier discharge, and speed recovery after elective surgery. It involves a coordinated preoperative, intraoperative, and postoperative care plan using multiple evidence-based practices. The goal is that a multimodal approach will have synergistic benefits over using individual components alone. Key elements include preoperative education and optimization, attenuating the surgical stress response intraoperatively through techniques like neural blockade, and aggressive postoperative rehabilitation with early feeding and mobility. Successful implementation requires significant resources and coordination across specialties.
The post anesthesia care unit (PACU) is where patients recover after surgery and anesthesia. It is equipped to monitor unstable patients while providing comfort for stable patients. Upon arrival, the anesthesiologist provides a report to the PACU nurse. Vital signs are closely monitored for complications like low oxygen, breathing issues, or irregular heart rate. Standard criteria govern PACU design, staffing, and discharge of stable patients once criteria are met, such as a score of 9 or higher on the Postanesthetic Discharge Scoring System. Common complications include nausea, breathing problems, and low blood pressure, which nurses are trained to quickly identify and treat.
1) Day case anesthesia, also known as ambulatory surgery or same-day surgery, allows patients to be admitted for a surgical procedure and investigation but return home the same day without an overnight hospital stay.
2) There has been a rapid expansion in the use of day case surgery over the last 30 years, with approximately 65% of surgeries in the United States now performed on an outpatient basis.
3) Day case anesthesia provides advantages like reduced costs, increased bed availability, and less risk of hospital-acquired infections compared to traditional inpatient surgery.
This document discusses preoperative and postoperative care. The goals of preoperative care are to optimize the patient's condition before surgery to achieve the best surgical outcome and minimize complications. This involves assessing risk factors, performing examinations and tests to evaluate fitness for surgery, and developing a management plan. Postoperative care focuses on recovery and addressing any medical issues that arise.
Similar to A C S0105 Postoperative Management Of The Hospitalized Patient (20)
Acs0522 procedures for benign and malignant biliary tract disease-2005medbookonline
This document discusses procedures for benign and malignant biliary tract diseases. It provides guidance on preoperative evaluation and management of biliary obstruction. Specific considerations are given to infection, renal dysfunction, impaired immunity, malnutrition, and coagulation issues. The document outlines operative planning details such as patient positioning, exposure techniques, and guidelines for biliary anastomoses including suture placement and techniques for difficult access situations.
This document discusses the anatomy and surgical procedure of splenectomy. It describes:
- The spleen's highly variable arterial blood supply, which can take bundled or distributed patterns. This variability impacts the difficulty of surgery.
- The splenic artery typically branches off the celiac axis but can originate from other nearby arteries in rare cases.
- Additional branches of the splenic artery before it enters the spleen, including short gastric and pancreatic arteries.
- A history of splenectomy beginning in the 16th century and its increasing use through the 20th century for trauma and hematologic disorders.
- The development of laparoscopic splenectomy in the early 1990s and ongoing refinement of minim
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to the skin. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and attached to form a mucosal lined tube to prevent regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach heals and functions return to normal.
This document describes the Billroth I gastric resection procedure, which involves removing part of the stomach and reattaching it to the duodenum. Key steps include transecting the stomach, attaching it to the duodenum using a circular stapler, and closing the gastrotomy site. The procedure aims to control peptic ulcers by combining hemigastrectomy with vagotomy while restoring normal gastrointestinal continuity. Postoperative care focuses on gradual advancement of oral intake and monitoring for complications.
This document describes the Billroth I procedure for gastroduodenostomy. It involves extensive mobilization of the stomach and duodenum to allow for an end-to-end anastomosis between the stomach and duodenum, restoring normal continuity of the gastrointestinal tract. The stomach is divided and sutured closed, then sutured to the duodenum in layers to create the gastroduodenal connection. Postoperative care focuses on gradual advancement of diet and monitoring for gastric retention to support healing and prevent complications.
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to prevent leakage. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and lined with mucosa to form a permanent opening, preventing regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach and bowel recover function.
Gastrojejunostomy is a surgical procedure that connects the stomach directly to the jejunum. It is indicated for patients with duodenal ulcers complicated by pyloric obstruction or nonresectable stomach or pancreatic cancers causing obstruction. The procedure involves opening the stomach and jejunum, suturing them together to form a stoma, then closing in multiple layers. Postoperatively, gastric emptying is monitored and diet advanced gradually to ensure proper healing.
This document provides guidance on treating a perforated ulcer or subphrenic abscess. It describes:
1) Preparing patients preoperatively by administering IV fluids/antibiotics and gastric suction.
2) Closing perforations by suturing the ulcer and reinforcing it with omentum, or sealing it if too indurated.
3) Draining subphrenic abscesses extraperitoneally by making incisions below the costal margin or through the 12th rib bed and inserting drains into the abscess cavity.
Postoperative pain is a complex experience involving sensory, emotional, and mental components. Effective pain management is important for patient comfort and recovery. Guidelines for postoperative pain treatment have been developed for specific procedures. Multimodal analgesic regimens targeting multiple pathways are recommended over reliance on opioids alone to prevent tolerance and hyperalgesia. Nonpharmacological complementary therapies can be combined with drug treatments to enhance pain control.
A C S0812 Brain Failure And Brain Deathmedbookonline
This document discusses brain failure and brain death. It defines different levels of impaired consciousness from cloudy consciousness to coma. It describes how brain failure results from cardiac arrest and the challenges of restarting the brain after lack of oxygen. It outlines the criteria for diagnosing brain death, including absence of brain stem reflexes and apnea testing. It also discusses the evolution of determining death as technology has allowed life support to prolong vital signs indefinitely.
This document discusses organ procurement from cadaveric donors. It describes the coordination between donor and recipient activities, including matching organs to recipients based on factors like blood type, medical urgency, and waiting time. The evaluation of donor organs is outlined for different organs. Careful donor management aims to optimize organs while respecting donor dignity.
Hand-assisted laparoscopic surgery (HALS) is a hybrid technique that provides many of the advantages of traditional open surgery and laparoscopic colectomy. HALS employs a special access device that allows the surgeon to place a hand in the abdomen to assist with retraction, dissection, and visualization while maintaining pneumoperitoneum and laparoscopic instrumentation through trocars. Studies have shown HALS results in shorter operative times and lower conversion rates to open surgery compared to traditional laparoscopic colectomy while preserving similar short-term clinical outcomes. HALS may help expand the use of minimally invasive approaches for complex colectomies by providing an easier transition from open surgery than traditional laparoscopic techniques.
The document summarizes the evolution of trauma surgery training and practice in the United States. It discusses how trauma surgery originated in large city hospitals but has since expanded to regional trauma centers. It also notes changes in surgical training away from generalist models towards increased specialization. Trauma surgery is increasingly encompassing broader emergency general surgery duties due to workforce shortages, while training programs emphasize specialized rather than broad skills.
This document provides reference values for many common clinical chemistry analytes measured in various specimens like plasma, serum, urine, and whole blood. The analytes include metabolic panels, lipids, proteins, electrolytes, vitamins, and more. Reference ranges are given in conventional and SI units for each analyte. The purpose is to provide clinicians with the normal expected ranges to interpret laboratory results at the Massachusetts General Hospital.
Acs0905 Gynecologic Considerations For The General Surgeonmedbookonline
This document discusses several gynecologic conditions and considerations for general surgeons:
- Gynecologic emergencies like bleeding from ovarian cysts, adnexal torsion, pelvic inflammatory disease, and ectopic pregnancy. Diagnosis and treatment approaches are outlined.
- Outpatient gynecologic problems including evaluating pelvic masses and abnormal uterine bleeding.
- Gynecologic malignancies like ovarian and cervical cancer that some general surgeons may encounter.
- Most conditions can be initially managed conservatively but may require surgery depending on patient stability or response to treatment. Diagnostic tools like ultrasound, CT, and laparoscopy are discussed.
Acs0904 Urologic Considerations For The General Surgeonmedbookonline
This document discusses urologic considerations for general surgeons. It begins with an overview of genitourinary anatomy, including the kidneys, ureters, bladder, prostate, seminal vesicles, penis, and urethra. It then discusses common urologic injuries general surgeons may encounter, such as those resulting from multiple trauma or iatrogenic injuries during other operations. Urologic malignancies and benign prostatic hyperplasia are also briefly mentioned.
This document discusses considerations for pediatric surgical patients. Some key points:
- Pediatric physiology differs significantly from adults, with higher fluid needs and electrolyte requirements. Careful fluid and electrolyte management is important.
- Nutritional needs are also higher in pediatric patients, especially infants, due to rapid growth. Enteral nutrition is preferred when possible, otherwise total parenteral nutrition may be needed. Close monitoring of nutrition and growth parameters is important.
- Vital signs and fluid intake/output norms differ for pediatric patients compared to adults. Recognizing what is normal for different pediatric age groups is essential for surgical care.
The document discusses considerations for elderly surgical patients. Older patients represent a growing demographic undergoing more procedures. While age alone is a poor indicator of health, the aging process involves physiological changes that reduce cardiac, pulmonary, renal and other organ reserves. Careful preoperative evaluation of functional status is important to assess risks. Perioperative strategies aim to support compromised systems and avoid stressors that can precipitate complications in elderly patients.
Acs0827 Blood Cultures And Infection In The Patient With The Septic Responsemedbookonline
This document discusses blood cultures and infection in patients with sepsis. It provides the following key points:
1) Positive blood cultures can identify the cause of infection and guide appropriate antibiotic therapy and search for infection sources. Common pathogens include staphylococci, enterococci, E. coli, and Candida.
2) Device-related infections are a major cause of bacteremia and the device (e.g. catheter) must be removed. Staphylococcal infections often involve devices.
3) Surgical site, device insertion sites, lungs, urine and intra-abdominal sites are common sources of infection that require drainage or debridement along with antibiotics.
Acs0826 Molecular And Cellular Mediators Of The Inflammatory Responsemedbookonline
This document discusses the molecular and cellular mediators of the inflammatory response. It describes how neutrophils play a key role in mediating inflammation through the release of reactive oxygen metabolites and proteases that can damage surrounding tissues. Neutrophils adhere to endothelial cells and migrate into tissues via adhesion molecules like selectins, integrins, and immunoglobulins. While neutrophils help fight infection, overactivation can cause excessive tissue damage through increased vascular permeability and parenchymal injury during conditions like reperfusion injury or sepsis. Controlling neutrophil adhesion is important for balancing the benefits of the immune response against potential tissue damage.