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Prevention and Treatment of Major Blood Loss — NEJM
Prevention and Treatment of Major Blood Loss. Pier Mannuccio Mannucci, M.D. and Marcel Levi, M.D., Ph.D. N Engl J Med 2007; 356:2301-2311May 31, 2007. Article. In a medical setting, surgery is the most common cause of major blood loss, ..... In a randomized, controlled trial involving 245 patients with cirrhosis and upper gastrointestinal bleeding (66% of whom had bleeding varices) who were being treated with standard endoscopic and pharmacologic interventions, ...
Omeprazole before Endoscopy in Patients with Gastrointestinal ...
The need for endoscopic treatment was lower in the omeprazole group than in the placebo group (60 of the 314 patients included in the analysis [19.1%] vs. 90 of 317 patients [28.4%], P=0.007). There were no significant differences between the omeprazole group and the placebo group ..... In patients with upper gastrointestinal bleeding, early endoscopy (usually defined as endoscopy performed within 24 hours after admission) should be the standard of care in most hospitals. ...
Nursing Care Plan | Hypovolemic/ Hemorrhagic Shock
Hypovolemic shock results from a decreased effective circulating volume of water, plasma, or whole blood and is the most common type of shock in adults and children. External, sudden blood loss resulting from penetrating trauma and severe ... When you auscultate the patient's abdomen, note the absence of bowel sounds, which may indicate a paralytic ileus, internal gastrointestinal bleeding, or peritonitis. If bowel sounds are hypoactive, bleeding may be causing blood to ...
Lower Gastrointestinal Bleeding
52 LOWER GASTROINTESTINAL BLEEDING
Kathleen Liscum M.D.
1. Describe the treatment of a patient who presents with lower gastrointestinal (GI) bleeding.
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Treatment begins with the ABCs (airway, breathing, circulation). Place two large-bore intravenous (IV) catheters in the upper extremities. Obtain hemoglobin and hematocrit levels, blood type, and cross-match. A Foley catheter should be placed to help monitor volume status.
2. What is the next step in evaluating the patient?
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A nasogastric tube should be placed to rule out an upper GI source. If the aspirate is bilious, the examiner can be fairly certain that the source is distal to the ligament of Treitz. However, if the aspirate reveals no bile, the patient may still be bleeding in the duodenum with a competent pylorus.
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Diverticular Disease Of The Colon
48 DIVERTICULAR DISEASE OF THE COLON
Gregory P. Victorino M.D., Jyoti Arya M.D., Lawrence W. Norton M.D.
1. What is a colonic diverticulum?
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A protrusion of mucosa and submucosa through the muscular layers of the bowel wall. It has no muscular covering. Because diverticula do not involve all layers of the bowel wall, they are really “false” diverticula. Diverticulum formation may be related either to weakness of the bowel wall at the sites of vessel perforation or to increased intraluminal pressure caused by low dietary fiber and constipation.
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Hepatic & Biliary Trauma. Operative Management Of Liver Injury
OPERATIVE MANAGEMENT OF LIVER INJURY
11. How are acute liver injuries classified?
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Liver wounds are generally graded on a scale of I to VI according the depth of parenchymal laceration and involvement of the hepatic veins or retrohepatic portion of the inferior vena cava. Optimal methods of obtaining hemostasis vary with the severity of the injury.
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pringle maneuver technique liver injury, biliary trauma, finger fracture hepatotomy, liver laceration surgical management, liver laceration/pringle maneuver, liver packing, billiary trauma and its management, finger fracture in liver injuries, grading liver lacerations surgical management, hepatic arterial bleeding management, hepatic fracture, hepatic fracture treatment, hepatic trauma and its management, indication hepatic artery ligation, is penrose drain required to provide pringle maneuver, laceration inferior vena cava, liver fracture surgical management, liver hemorrhage maneuver, liver injury-operative steps, liver laceration management, liver packing for trauma, liver packing in trauma, liver trauma-operative steps, management of hepatic trauma, management of liver injuries, management of liver trauma, operative indications liver laceration, operative management of liver injury, operative management of liver trauma bile, option to control liver hemorrhage,UPPER GASTROINTESTINAL BLEEDING
51 UPPER GASTROINTESTINAL BLEEDING
G. Edward Kimm Jr. M.D., Allen T. Belshaw M.D.
1. What is upper gastrointestinal (GI) bleeding?
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Bleeding from proximal to the ligament of Treitz (the transition point between duodenum and jejunum).
2. What are the most common causes of upper GI bleeding?
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In descending order of frequency, they are gastritis, duodenal ulcer, esophageal varices, benign gastric ulcer, esophagitis, and Mallory-Weiss tear. All other causes account for < 5% of cases.
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can a upper gi miss a duodenal ulcer, esophageal gastroduodenotomy with esophageal banding,Properties In Evaluation Of The Acute Abdomen
14 PRIORITIES IN EVALUATION OF THE ACUTE ABDOMEN
Alden H. Harken M.D.
1. What is the surgeon’s responsibility when confronted by a patient with an acute abdomen?
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1. To identify how sick the patient is
2. To determine whether the patient (a) needs to go directly to the operating room, (b) should be admitted for resuscitation or observation, or (c) can be sent safely home
Ethics In The Surgical Intensive Care Unit
102 ETHICS IN THE SURGICAL INTENSIVE CARE UNIT
Ricardo J. Gonzalez M.D.
1. What are the four principles of medical ethics?
1. Beneficence describes the active role of doing good by intervention.
2. Nonmaleficence is equivalent to saying, “First do no harm.”
3. Autonomy accounts for informed consent, competence, and the patient’s right to refuse treatment and to know what’s going on.
4. Justice means that all patients should receive fair and equal care but that one patient’s care should not squander limited resources for others.
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Lower Urinary Tract Injury & Pelvic Trauma
31 LOWER URINARY TRACT INJURY AND PELVIC TRAUMA
Fernando J. Kim M.D., Siam Oottamasathien M.D.
1. What are the causes of bladder injury?
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Iatrogenic manipulation and penetrating or blunt trauma. Because of the rich detrusor blood supply, bladder injury is usually accompanied by hematuria. Other signs may include suprapubic pain, inability to void, or incomplete recovery of catheter irrigation.
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Properties In Evaluation Of The Acute Abdomen. Physical Exam
PHYSICAL EXAMINATION
7. Are vital signs important?
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Yes. They are vital. If heart rate and blood pressure are on the wrong side of 100 (heart rate > 100 beats/min, systolic blood pressure < 100 mmHg), watch out! Tachypnea (respiratory rate >16) reflects either pain or systemic acidosis. Fever may develop late, particularly in the immunosuppressed patient who may be afebrile in the face of florid peritonitis.
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MITRAL REGURGITATION
76 MITRAL REGURGITATION
David A. Fullerton M.D., Glenn J.R. Whitman M.D.
1. List the causes of mitral regurgitation.
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* Rheumatic fever
* Endocarditis
* Ruptured chordae tendineae
* Senile mitral annular calcification
* Papillary muscle dysfunction from ischemia
* Annular dilatation from left ventricular dilation
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Surgical Approach To Infertility
93 THE SURGICAL APPROACH TO INFERTILITY
Randall B. Meacham M.D., Alex J. Vanni
1. How common a problem is infertility?
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Infertility is the inability to establish a pregnancy during 1 year of well-timed intercourse. This affects 15% of all couples in the United States. In 50% of such couples, the woman is responsible; in 30% of couples, a male factor prevents pregnancy; and in 20% of couples, it is a combination of both.
Diagnosis & Therapy of Chronic Pancreatitis
41 DIAGNOSIS AND THERAPY OF CHRONIC PANCREATITIS
Clay Cothren M.D., Jon M. Burch M.D.
1. What is chronic pancreatitis?
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The classic syndrome consists of smoldering abdominal pain and evidence of pancreatic insufficiency. Histologically, chronic inflammation results in destruction of the functioning endocrine and exocrine pancreatic cells.
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answers to chronic pancreatitis secondary to alcoholism, http://www ascsurgery com/abstracts/acs/acs0304/htm,Properties In Evaluation Of The Acute Abdomen. Lab Stadies
LABORATORY STUDIES
15. How is a complete blood count helpful?
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1. Hematocrit. If the hematocrit is high (> 45%), the patient is most likely dry or may have chronic obstructive pulmonary disease. If it is low (< 30%), the patient probably has a more chronic disease (associated with blood loss-always do a rectal and test the stool for blood).
2. White blood cell count. It takes hours for inflammation to release cytokines and elevate the white blood cell count. A normal white blood cell count is entirely consistent with significant abdominal trouble. Read more
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, acute abdomen lab, acute adbomen, lab activity on evaluation of the abdomen, labs air in stomach, recovery free air in abdomen, symptoms of mesh rejection, three way of the abdomen,Surgical Infectious Disease
15 SURGICAL INFECTIOUS DISEASE
Glenn W. Geelhoed M.D., M.P.H., DTMH
1. Have modern antibiotic developments controlled many, if not most, of the problems of surgical infection?
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No. In seriously ill surgical patients in intensive care unit (ICU) settings, the problems of sepsis have increased and remain among the principal causes of death in ICU patients, especially those with multiple organ failure and impairments of host defense. Antibiotic treatment may change the biographical sketch of the flora associated with patients’ deaths but cannot overcome the multiple causes of failing host resistance to infection that accompany barrier breeches to microbial invasion and the inflammatory and immunologic responses to the “usual suspects.”
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Posttraumatic Hemorrhagic Shock
17 POSTTRAUMATIC HEMORRHAGIC SHOCK
John B. Moore M.D., Ernest E. Moore M.D.
1. Are hemorrhagic shock and hypovolemic shock the same?
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Yes.
2. What is hemorrhagic shock?
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Shock exists when the cardiovascular system is no longer able to meet the body’s metabolic and oxygen needs-inadequate tissue perfusion.
Hemorrhage is the most common cause of shock after injury. Depletion of the vascular volume results in decrease of the driving pressure returning blood to the heart, decrease of the end-diastolic ventricular volume, and decrease in stroke volume; all result in decrease in cardiac output.
Surgical Hypertension
60 SURGICAL HYPERTENSION
Thomas A. Whitehill M.D.
1. What are the surgically correctable causes of hypertension?
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Renovascular hypertension, pheochromocytoma, Cushing’s syndrome, primary hyperaldosteronism (Conn’s syndrome), coarctation of the aorta, and unilateral renal parenchymal disease. Surgical hypertension accounts for 5% of all hypertensive patients.
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conn cushing coarctation,
Abernathy’s Surgical Secrets, Updated Edition (Book w / Student Consult)
Author / s: Harken Alden H., Abernathy Charles, Moore Ernest Eugene
Year: 2004
Pages: 473
Publishers: Elsevier Mosby; 5th Bk & Acc edition
ISBN: 0323034160
