By David M. Rothenberg M.D. (auth.), Keith W. Millikan M.D., Theodore J. Saclarides M.D. (eds.)
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Additional resources for Common Surgical Diseases: An Algorithmic Approach to Problem Solving
Drains Wounds Anastamosls J. I. Fever H. Volume status Oxygenation Ventilation G. F. Mental Status Old lines Lungs Wound Blood pressure Heart rate Filling pressure Urine output Respiratory rate Respiratory effort Pulse oximetry Arterial blood gas ~ I ~. ~ i g' ~ ~ t::. D. A systematic approach to the initial care of the traumatized patient should determine the presence of immediately life-threatening injuries and provide prompt treatment. At each step an assessment is made and any necessary interventions are performed.
When surgery must be performed on these patients, special attention to local hemostasis is critical since there is an increased risk of postoperative hematoma. Specific therapy with cryoprecipitate and/or DDA VP can be useful when von Willebrand's factor deficiency is known preoperatively. Cryoprecipitate is concentrated in von Willebrand's factor, fibrinogen and factor VIII. Hematologists should be consulted when using these products. G. Clinically significant bleeding secondary to clotting factor deficiency occurs when serum factor levels fall below 30% of normal.
F. Patients taking aspirin and other non-steroidal anti-inflammatory agents may have dysfunctional platelets; these drugs should be avoided, therefore, during the peri-operative period. Aspirin inactivates cyclo-oxygenase, blocking the production of thromboxane A2 and preventing normal platelet function during the platelet's lifetime. Uremia may also cause platelet dysfunction, however, the pathophysiology of this is not known. When surgery must be performed on these patients, special attention to local hemostasis is critical since there is an increased risk of postoperative hematoma.
Common Surgical Diseases: An Algorithmic Approach to Problem Solving by David M. Rothenberg M.D. (auth.), Keith W. Millikan M.D., Theodore J. Saclarides M.D. (eds.)