By David M. Rothenberg M.D. (auth.), Keith W. Millikan M.D., Theodore J. Saclarides M.D. (eds.)
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Extra resources for Common Surgical Diseases: An Algorithmic Approach to Problem Solving
Malposition of the endotracheal tube, pneumothorax, and hemothorax are common reasons for ineffective ventilation. Tension pneumothorax should be considered in hemodynamically unstable patients with decreased or absent breath sounds on one side; in these instances, the trachea may be deviated to the opposite side. Decompression by needle thoracostomy should be performed immediately, before obtaining a chest x-ray. Hemothorax is treated with insertion of a large bore (32-40 Fr) chest tube. Traumatic pneumothorax is always accompanied by some degree of hemothorax and therefore also requires a large tube to evacuate blood.
Note that calcium and phosphorus provided in large amounts in TPN can combine to produce crystalline precipitate which can cause catheter occlusion. Vitamins, minerals and trace elements should be added to meet the Recommended Daily Allowance with additional supplementation for documented deficiencies. Adequate water must be provided to prevent azotemia. E. Monitoring protocols for TPN are institution specific and include assessment of minerals, electrolytes, triglyceride levels, liver function tests, serum glucose, CBC with differential, PT and PTT, fluid inputs and outputs, weight, and protein store changes.
C. I' • N10 Evaluate and place venous access device F. Initiate and advance TPN to goal 1 G. Transition to tube feedings when GI tract functional and appropriate access placed E. , minerals and triglycerldes • D. Determine Individual nutrition requirements and restrictions to formufate goaf TPN Preoperative Evaluation David M. D. The preoperative evaluation consists of identifying both surgical and anesthetic risk. Given that the administration of a regional or general anesthetic is often more of a hazard than the actual surgery, the preanesthetic assessment is therefore the most important preoperative evaluation in assuring patient safety.
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.)