On Call Surgery: On Call Series

Description

Ideal for any on-call professional, resident, or medical student, this best-selling reference by Drs. Gregg A. Adams, Stephen D. Bresnick, Jared Forrester, and Graeme Rosenberg covers the common problems you’ll encounter while on call without direct supervision in the hospital. On Call Surgery, 4th Edition, fits perfectly in your pocket, ready to provide key information in time-sensitive, challenging situations. You’ll gain speed, skill, and knowledge with every call - from diagnosing a difficult or life-threatening situation to prescribing the right medication. Highlights medications, doses, and critical information in a second color for fast reference. Features a logical, highly templated format so you can locate key information quickly. Delivers consistent, easy-to-follow coverage of the most common on-call problems and approaches, including what to do from the initial phone call, questions you should ask to assess the urgency of each situation, "Elevator Thoughts," how to immediately identify major threats to life, what to do at the bedside, and how to avoid common mistakes for every call. Provides updated content and references, as well as an up-to-date drug formulary, keeping you on the cutting edge of current, evidence-based information. NEW! Expert Consult™ eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, and references from the book on a variety of devices. Front Cover IFC ON CALL Surgery Series Page ON CALL Surgery Copyright Dedication Preface Acknowledgments Structure of the Book ?Phone Call Questions Orders Inform RN ?Elevator Thoughts ?Major Threat To Life Surgical Chart Biopsy ?Bedside Quick Look Test Airway and Vital Signs Selective History, Chart Review, and Physical Examination Management Contents Introduction 1 - Approach to On-Call Surgical Problems ?PHONE CALL ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE Surgical Chart Biopsy Recommendations ?BEDSIDE Quick Look Test Vital Signs Selective History, Chart Review, and Physical Examination MANAGEMENT SPECIAL SURGICAL CONSIDERATIONS FURTHER INFORMATION 2 - Special Considerations for Surgical Patients PATIENT CONSIDERATIONS PREOPERATIVE CONSIDERATIONS POSTOPERATIVE CONSIDERATIONS 3 - Documentation of On-Call Problems Resident On-Call Note Communication “Loading the Boat” 4 - On-Call Hazards Patient-Related Problems: The Common Calls 5 - Abdominal Pain ?PHONE CALL Questions Orders Degree of Urgency ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE Surgical Chart Biopsy ?BEDSIDE Quick Look Test Airway and Vital Signs Initial Assessment Abdominal Distention Quiet Abdomen Peritonitis Hypotension Selective History and Chart Review Selective Physical Examination MANAGEMENT Gastritis or Peptic Ulcer Disease (Non-Perforated) Clues to Diagnosis Perforated Peptic Ulcer Clues to Diagnosis Acute Cholecystitis Clues to Diagnosis Ascending Cholangitis Clues to Diagnosis Pancreatitis Clues to Diagnosis Hepatitis Clues to Diagnosis Acute Appendicitis Clues to Diagnosis Acute Diverticulitis Clues to Diagnosis Acute Obstruction of the Small Intestine Clues to Diagnosis Acute Obstruction of the Large Intestine Clues to Diagnosis Volvulus Clues to Diagnosis Mesenteric Ischemia Clues to Diagnosis Bowel Infarction Clues to Diagnosis Abdominal Abscess Clues to Diagnosis Renal Calculi Clues to Diagnosis Ruptured Abdominal Aortic Aneurysm Clues to Diagnosis Acute Salpingitis Clues to Diagnosis Acute Salpingitis Clues to Diagnosis Ectopic Pregnancy Clues to Diagnosis Special Surgical Considerations ?REMEMBER 6 - Bowel Function—Constipation and Diarrhea CONSTIPATION ?PHONE CALL Questions Orders Oral Laxatives Rectal Laxatives Enemas What to Use and When—Some Suggestions Notes DIARRHEA ?PHONE CALL Questions Orders MANAGEMENT Antibiotic-Induced Diarrhea Antibiotic-Induced Colitis Noninvasive Gastroenteritis INVASIVE GASTROENTERITIS Inflammatory Bowel Disease Feeding-Associated Diarrhea Other Causes of Diarrhea 7 - Chest Pain ?PHONE CALL Questions Orders Informing the RN Surgical Chart Biopsy ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test: Sick or Not Sick Airway and Vital Signs If the Patient is Hypotensive Selective History and Chart Review Selective Physical Examination MANAGEMENT Initial Management—If Unstable, Remember the ABCs (Airway, Breathing, Circulation) Definitive Management Myocardial Ischemia RESOLVING ANGINA NEW-ONSET OR UNSTABLE ANGINA ACUTE MYOCARDIAL INFARCTION ACUTE PERICARDITIS ASSOCIATED WITH MI Aortic Dissection Pneumothorax Pulmonary Embolism Reflux Esophagitis or Gastroesophageal Reflux Disease (GERD) Pneumonia Musculoskeletal Pain 8 - Drug Reactions RASHES AND ANAPHYLAXIS ?PHONE CALL Questions Orders Degree of Urgency Surgical Chart Biopsy ?ELEVATOR THOUGHTS Urticaria Maculopapular (Morbilliform) Vesicular Purpuric Exfoliative Dermatitis Fixed Drug Reactions ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Airway and Vital Signs Selective History and Chart Review Selective Physical Examination MANAGEMENT Initial Management Definitive Management SPECIFIC IMPORTANT RASHES Urticaria Herpes Zoster Petechiae Purpura ?REMEMBER OTHER DRUG REACTIONS ?BEDSIDE Quick Look Test Airway and Vital Signs Selective History and Chart Review Selective Physical Examination MANAGEMENT Initial Management 9 - Dysrhythmias BRADYCARDIAS ?PHONE CALL Questions Orders Informing the RN Surgical Chart Biopsy ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Airway and Vital Signs Selective History and Chart Review Selective Physical Examination MANAGEMENT If the Patient is Hypotensive Sinus Bradycardia Atrial Fibrillation with Slow Ventricular Response AV Block Drug Overdose TACHYCARDIAS AND IRREGULAR RHYTHMS ?PHONE CALL Questions Orders Informing the RN Surgical Chart Biopsy ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Airway and Vital Signs MANAGEMENT If the Patient Is Hypotensive TACHYCARDIAS WITH REGULAR RHYTHMS SINUS TACHYCARDIA Atrial Tachycardia Paroxysmal Atrial Tachycardia Atrial Flutter Unstable Hemodynamics Stable Hemodynamics AV Nodal Reentrant Tachycardia Unstable Hemodynamics Valsalva’s Maneuver AV Nodal Blockade Carotid Massage Wolff–Parkinson–White Syndrome Ventricular Tachycardia Unstable Hemodynamics Stable Hemodynamics TACHYCARDIAS WITH IRREGULAR RHYTHMS ATRIAL FIBRILLATION Unstable Hemodynamics Stable Hemodynamics Multifocal Atrial Tachycardia Sinus Tachycardia with Premature Atrial Contractions or Premature Ventricular Contractions IRREGULAR RHYTHMS NOT COMPATIBLE WITH LIFE VENTRICULAR FIBRILLATION Asystole/Pulseless Electrical Activity (PEA) SPECIAL SURGICAL CONSIDERATIONS 10 - Falls ?PHONE CALL Questions Orders Informing the RN ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE Causes of Falls Result of Falls Head Injury Fractures ?BEDSIDE Quick Look Test Airway and Vital Signs Initial Management Selective History and Chart Review Selective Physical Examination MANAGEMENT Special Surgical Considerations Preoperative Considerations Postoperative Considerations Other Important Consideration 11 - Fever ?PHONE CALL Questions Orders Informing the RN ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE Surgical Chart Biopsy ?BEDSIDE Quick Look Test Airway and Vital Signs Selective History and Chart Review Selective Physical Examination MANAGEMENT Initial Management (If Patient Is Unstable) Definitive Management Patients Who Require Empirical Broad-Spectrum Antibiotic Therapy Patients Who Require Directed Antibiotic Treatment Patients Who Require No Immediate Antibiotic Therapy Patients With Fever Already Taking Antibiotics Patients With Fever in Whom Surgical Intervention Should be Considered Special Surgical Considerations Preoperative Considerations Postoperative Considerations Malignant Hyperthermia 12 - Fluids, Electrolytes, and Acid–Base Status NORMAL FLUID DISTRIBUTION PREOPERATIVE FLUID DEFICITS POSTOPERATIVE FLUID CHANGES RAPID FLUID STATUS ASSESSMENT COMMON FLUID IMBALANCES: THE FLUID-OVERLOADED PATIENT ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Airway and Vital Signs Selective History and Chart Review Selective Physical Examination MANAGEMENT Initial Management Definitive Management COMMON FLUID IMBALANCES: THE FLUID-DEPLETED PATIENT ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Airway and Vital Signs Selective History and Chart Review Selective Physical Examination MANAGEMENT Initial Management Definitive Management REPLACEMENT OF FLUID DEFICITS TYPES OF FLUID REPLACEMENT Red Blood Cells Advantages Disadvantages Blood Products Advantages Disadvantages Colloid Advantages Disadvantages Crystalloid Advantages Disadvantages SPECIAL SURGICAL CONSIDERATIONS Burn Patients Remember COMMON ELECTROLYTE ABNORMALITIES Sodium (Na+) Hypernatremia (>147 mmol/L) Etiology Selective Physical Examination Management Special Surgical Considerations Hyponatremia (3.5 mmol/L) ?MAJOR THREAT TO LIFE Selective Physical Examination Management Calcium (Ca2+) CALCIUM METABOLISM Hypercalcemia (>2.6 mmol/L) Etiology ?MAJOR THREAT TO LIFE Selective Physical Examination Management Hypocalcemia (>2.2 mmol/L) ?MAJOR THREAT TO LIFE Selective Physical Examination Management Special Surgical Considerations Magnesium (Mg2+) MAGNESIUM METABOLISM Etiology MAJOR THREAT TO LIFE Selective Physical Examination Management Etiology ?MAJOR THREAT TO LIFE Selective Physical Examination Management Common Acid–Base Abnormalities ACIDOSIS (PH 7.45) Etiology ?MAJOR THREAT TO LIFE Selective Physical Examination Management Etiology ?MAJOR THREAT TO LIFE Selective Physical Examination Management MIXED ACID–BASE DISORDERS Chronic Respiratory Acidosis Plus Metabolic Alkalosis Acute Respiratory Acidosis Superimposed on Chronic Respiratory Acidosis Acute Respiratory Acidosis Superimposed on Metabolic Acidosis Respiratory Alkalosis Plus Metabolic Alkalosis 13 - GASTROINTESTINAL BLEEDING ?PHONE CALL Questions Orders Informing the RN Surgical Chart Biopsy ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE Hypovolemic Shock/Exsanguination ?BEDSIDE Quick Look Test Airway and Vital Signs Airway Vital Signs Selective Physical Examination I INITIAL MANAGEMENT Selective History and Chart Review Selective Physical Examination II DEFINITIVE MANAGEMENT Upper GI Bleeding Lower GI Bleeding 14 - Glucose Management and Surgical Nutrition BASIC METABOLIC REQUIREMENTS CHANGES IN METABOLIC NEEDS RELATED TO SURGERY Protein Lipid Carbohydrate MEANS OF DELIVERING CALORIES Enteral Oral Feeding Tubes Parenteral SPECIAL SURGICAL CONSIDERATIONS Normal Return of Bowel Function After Abdominal Procedures THE DIABETIC PATIENT PERIOPERATIVE INSULIN MANAGEMENT Preoperative Postoperative HYPERGLYCEMIA Etiology Major Threat To Life Selective Physical Examination Management MILD HYPERGLYCEMIA MODERATE HYPERGLYCEMIA SEVERE HYPERGLYCEMIA Diabetic Ketoacidosis Hyperosmolar Hyperglycemic Nonketotic Coma HYPOGLYCEMIA Etiology Major Threat To Life Brain Hypoglycemia Selective Physical Examination Management Nutrition and Wound Healing 15 - Headache ?PHONE CALL Questions Orders Informing the RN Surgical Chart Biopsy ?ELEVATOR THOUGHTS Slow-Onset or Chronic Headache Acute Headache Infectious Causes Vascular Causes Increased ICP Causes Local Causes ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Airway and Vital Signs Selective Physical Examination I Initial Management Headache Associated With Increased ICP Headache Associated With Nuchal Rigidity and No Sign of Increased ICP Headache with Nuchal Rigidity and Signs of Increased ICP Selective History and Chart Review Selective Physical Examination II Definitive Management Evidence of Head Trauma Posttraumatic Headache Postsurgical Patients Pseudotumor Cerebri Migraine Headache Cluster Headache Tension Headache Temporal Arteritis Malignant Hypertension Meningitis 16 - Hypertension ?PHONE CALL Questions Orders Informing the RN ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE Surgical Chart Biopsy ?BEDSIDE Quick Look Test Airway and Vital Signs Selective History and Chart Review Selective Physical Examination MANAGEMENT Hypertensive Crisis AORTIC DISSECTION PREECLAMPSIA AND ECLAMPSIA HYPERTENSIVE ENCEPHALOPATHY HYPERTENSION ASSOCIATED WITH MYOCARDIAL ISCHEMIA OR PULMONARY EDEMA CATECHOLAMINE CRISIS 17 - Hypotension and Shock ?PHONE CALL Questions Orders Degree of Urgency Surgical Chart Biopsy ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Airway and Vital Signs Bradycardia Tachycardia Initial Management Selective Physical Examination MANAGEMENT Normalize Intravascular Volume Give Inotropic Agents CARDIOGENIC SHOCK Hypotension and Elevated SVR (clinically demonstrated by ↑JVD) HYPOVOLEMIC SHOCK Hypotension with Fluid Loss or Redistribution SEPTIC SHOCK Hypotension and Fever ANAPHYLACTIC SHOCK NEUROGENIC SHOCK Hypotension and History of Recent Spinal Cord Injury IRREVERSIBLE SHOCK AND MULTIPLE ORGAN FAILURE SYNDROME SPECIAL SURGICAL CONSIDERATIONS Preoperative Considerations Postoperative Considerations ?REMEMBER 18 - Insomnia ?PHONE CALL Questions Orders 19 - Intravascular Access LOSS OF LINE FUNCTION ?PHONE CALL Questions Orders Degree of Urgency ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE Surgical Chart Biopsy ?BEDSIDE Quick Look Test Airway and Vital Signs Selective Physical Examination MANAGEMENT SPECIAL SURGICAL CONSIDERATIONS BLEEDING FROM THE SITE ?PHONE CALL Questions Orders Degree of Urgency ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE Surgical Chart Biopsy ?BEDSIDE Quick Look Test Airway and Vital Signs MANAGEMENT PURULENCE AT THE SITE ?PHONE CALL Questions Orders Degree of Urgency ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE Surgical Chart Biopsy ?BEDSIDE Quick Look Test Airway and Vital Signs MANAGEMENT SHORTNESS OF BREATH AFTER INSERTION OF A CENTRAL LINE ?PHONE CALL Questions Orders Degree of Urgency ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE Surgical Chart Biopsy ?BEDSIDE Quick Look Test Airway and Vital Signs Selective Physical Examination MANAGEMENT PLACEMENT OF INTRAVASCULAR LINES Sterile Technique Seldinger Technique Contraindications and Precautions Equipment Needed Procedure FORMS OF INTRAVASCULAR ACCESS Arterial Lines Peripheral Arterial Line With an Angiocatheter Indications Contraindications and Precautions Equipment Needed Procedure FEMORAL ARTERIAL LINE BY SELDINGER TECHNIQUE Indications Contraindications and Precautions Equipment Needed Procedure Removal of Arterial Lines Complications and Problems of Arterial Lines Procedures CENTRAL VENOUS LINES Subclavian Approach Indications Contraindications and Precautions Equipment Needed Anatomic Landmarks (Figs. 19.4 and 19.5) Procedure Internal Jugular Vein Approach Indications Contraindications and Precautions Equipment Needed Anatomic Landmarks (see Figs. 19.4 and 19.5) Femoral Vein Approach Indications Contraindications and Precautions Equipment Needed Anatomic Landmarks (see Fig. 19.3) Procedure Removal of Central Venous Lines Complications and Problems of Central Venous Line Procedures Central Line-Associated Bloodstream Infection PERIPHERAL VENOUS LINES Indications Contraindications and Precautions Equipment Needed Anatomic Landmarks Procedure Removal of Peripheral Lines Complications and Problems of Peripheral Lines 20 - Leg Pain ?PHONE CALL Questions Informing the RN Surgical Chart Biopsy ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE Acute Arterial Insufficiency Deep Venous Thrombosis Infectious Processes Compartment Syndrome ?BEDSIDE Quick Look Test Airway and Vital Signs Heart Rate, Blood Pressure, and Respiratory Rate Temperature Selective History and Chart Review Selective Physical Examination MANAGEMENT VASCULAR DISEASES Selective History Selective Physical Examination Management Deep Venous Thrombosis Selective History Selective Physical Examination Diagnostic Testing Management Perioperative Prophylaxis for DVTs Superficial Venous Thrombosis INFLAMMATORY AND DEGENERATIVE DISEASES Acute Gout and Pseudogout Acute Gout Pseudogout SOFT-TISSUE AND BONE PROCESSES Compartment Syndrome Selective Physical Examination INFECTIOUS PROCESSES Cellulitis Septic Arthritis Selective History Management Gram Stain-Positive for Organisms Gram Stain-Negative for Organisms Necrotizing Fasciitis Selective History Selective Physical Examination Management 21 - Mental Status Changes ?PHONE CALL Questions Orders Degree of Urgency ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE Surgical Chart Biopsy ?BEDSIDE Quick Look Test Airway and Vital Signs Initial Management Selective History and Chart Review Selective Physical Examination MANAGEMENT Medications Narcotic Medication Benzodiazepine Medication Specific Drug Overdose HERNIATION OR MASS LESION ALCOHOL WITHDRAWAL Signs and Symptoms Management Complications PRIMARY PSYCHIATRIC DISEASE SPECIAL SURGICAL CONSIDERATIONS Preoperative Considerations Postoperative Considerations Remember 22 - Nausea and Vomiting ?PHONE CALL Questions Informing the RN Surgical Chart Biopsy ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Airway and Vital Signs Selective History Selective Physical Examination MANAGEMENT The Unstable Patient with Severe Vomiting The Stable Patient With Nausea and Vomiting Special Surgical Considerations 23 - Pain Management ?PHONE CALL Questions Orders Informing the RN ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE Surgical Chart Biopsy ?BEDSIDE Quick Look Test Airway and Vital Signs Selective History and Chart Review Selective Physical Examination MANAGEMENT Non-Narcotic Agents Combination Agents Narcotic Agents Dose Lockout Interval Basal Rate Narcotic Antagonists Other Pain Management Options 24 - Preoperative Preparation NUTRITION HYDRATION PROPHYLACTIC ANTIBIOTICS MECHANICAL BOWEL PREPARATION CARDIAC RISK ASSESSMENT PREOPERATIVE LABORATORY STUDIES BLOOD PRODUCT REPLACEMENT OTHER CONSIDERATIONS PSYCHOLOGICAL PREPARATION PREOPERATIVE NOTE 25 - Pronouncing Death and End-of-Life Issues STEPS FOR PRONOUNCING PHYSIOLOGIC DEATH The Non-Ventilated Patient The Ventilated Patient AFTER YOUR EXAMINATION BRAIN DEATH AND ORGAN DONATION END-OF-LIFE ISSUES ?PHONE CALL Questions Orders Degree of Urgency ?ELEVATOR THOUGHTS Surgical Chart Biopsy ?BEDSIDE Quick Look Test Airway MANAGEMENT PALLIATIVE CARE COMFORT CARE 26 - Postoperative Bleeding ?PHONE CALL Orders Informing the RN Surgical Chart Biopsy ?ELEVATOR THOUGHTS Surgical Causes Technical Surgical Errors Bleeding From Surgical Sites Medical Causes Platelets Soluble Blood-Clotting Factors ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Airway and Vital Signs Selective History and Chart Review Selective Physical Examination MANAGEMENT Special Surgical Considerations of Postoperative Bleeding Whipple (Pancreaticoduodenectomy) Open Tracheostomy Minor Postoperative Bleeding Medical Bleeding Platelets THROMBOCYTOPENIA PLATELET DYSFUNCTION Soluble Blood-Clotting Factors 27 - Seizures ?PHONE CALL Questions Degree of Urgency Orders If the Patient Is Actively Having a Seizure If the Patient Is Postictal ?ELEVATOR THOUGHTS Central Nervous System ?MAJOR THREAT TO LIFE Surgical Chart Biopsy IF THE PATIENT IS ACTIVELY HAVING A SEIZURE ?BEDSIDE Quick Look Test Airway and Vital Signs Initial Management If the Seizure Lasts Longer Than 3 Minutes IF THE PATIENT HAS STOPPED HAVING THE SEIZURE ?Bedside Quick Look Test Airway and Vital Signs Initial Management Selective History and Chart Review Selective Physical Examination Management Special Surgical Considerations Preoperative Considerations Postoperative Considerations 28 - SHORTNESS OF BREATH ?PHONE CALL Questions Orders Degree of Urgency Surgical Chart Biopsy ?ELEVATOR THOUGHTS Cardiovascular Causes Pulmonary Causes Miscellaneous Causes ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Airway and Vital Signs IF THE PATIENT IS HYPOXIC Initial Management Selective History and Chart Review CARDIOVASCULAR CAUSES PULMONARY CAUSES MISCELLANEOUS CAUSES Selective Physical Examination Management Congestive Heart Failure Pulmonary Embolism Tamponade EMERGENCY PERICARDIOCENTESIS TECHNIQUE (STERILE) COMPLICATIONS OF EMERGENCY PERICARDIOCENTESIS Atelectasis Reactive Airway Disease (Asthma and COPD) Pneumothorax Pleural Effusion Pneumonia Aspiration of Gastric Contents Special Surgical Considerations Preoperative Considerations PULMONARY EMBOLISM ATELECTASIS REACTIVE AIRWAY DISEASE Postoperative Considerations THORACIC SURGERY ABDOMINAL SURGERY RESPIRATORY FAILURE 29 - Syncope ?PHONE CALL Orders Informing the RN ?ELEVATOR THOUGHTS Cardiovascular Causes Reflex-Vagal Causes Neurologic Causes Psychiatric Causes ?MAJOR THREAT TO LIFE Dysrhythmia Aspiration Intracranial Bleeding Falls Surgical Chart Biopsy ?BEDSIDE Quick Look Test Airway and Vital Signs Airway Heart Rate Blood Pressure Temperature Selective History and Chart Review Selective Physical Examination MANAGEMENT Syncope Caused by Cardiac Events Syncope Caused by Vagal Events Syncope Caused by Orthostatic Hypotension Syncope Caused by Psychological Factors Syncope Caused by Neurologic Events 30 - Trauma ?PHONE CALL ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE Hemorrhagic Shock Six Lethal Thoracic Injuries Neurogenic Shock Cardiogenic Shock ?BEDSIDE Trauma Bay/Resuscitation Bay Primary Survey (ABCDE; Always Follow The Alphabet!) ADJUNCTS TO THE PRIMARY SURVEY Secondary Survey MANAGEMENT LABORATORY TEST RADIOGRAPHIC TESTS BASIC TRAUMA PROCEDURES RAPID SEQUENCE INTUBATION (RSI) Indications Equipment Needed/Preparation Procedure CRICOTHYROIDOTOMY Indications Equipment Needed Procedure (Fig. 30.6) Emergency/Resuscitative Thoracotomy Indications Contraindications Equipment Needed Procedure (Fig 30.7) TUBE THORACOSTOMY INTRAOSSEOUS LINE PLACEMENT Indications Contraindications Equipment Needed Procedure (Fig. 30.8) 31 - Tubes and Drains CHEST TUBES Placement of a Tube Thoracostomy Indications Precautions Equipment Needed Anatomy and Approach Anesthesia Technique (Sterile) Complications/Problems Pigtail Chest Catheter Complications/Problems Pleurodesis Through a Tube Thoracostomy Indications Contraindications Equipment Needed Anesthesia Technique (Sterile) Complications Removal of a Tube Thoracostomy Complications of Tube Thoracostomy PROBLEMS WITH CHEST TUBES PHONE CALL Questions Degree of Urgency ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Selective History and Chart Review Selective Physical Examination MANAGEMENT Persistent Blood Leak Through the Chest Tube ?PHONE CALL Questions Orders Degree of Urgency ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Airway and Vital Signs Selective History and Chart Review MANAGEMENT Special Surgical Considerations Postoperative Considerations Bleeding at the Entry Site ?PHONE CALL Questions Degree of Urgency ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Airway and Vital Signs Selective History and Chart Review MANAGEMENT Loss of Underwater Seal Fluctuation ?PHONE CALL Questions Degree of Urgency ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Airway and Vital Signs Selective History and Chart Review MANAGEMENT Shortness of Breath ?PHONE CALL Questions Orders Degree of Urgency ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Selective History and Chart Review Selective Physical Examination MANAGEMENT Subcutaneous Emphysema ?PHONE CALL Questions Degree of Urgency ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Airway and Vital Signs Selective History and Chart Review MANAGEMENT Equipment Procedure ?REMEMBER URINARY DRAINAGE TUBES Transurethral Catheters Catheter Associated Urinary Tract Infections Placement of Transurethral Tubes (Foley Catheters) Indications Contraindications and Precautions Equipment Needed Anesthesia Placement Technique MALE PATIENT FEMALE PATIENT Suprapubic Tubes Indications Complications of Urinary Drainage Tubes Problems With Urinary Drainage Tubes Blocked Urethral Catheter ?PHONE CALL Questions Orders Degree of Urgency ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Airway and Vital Signs Selective History and Chart Review Selective Physical Examination MANAGEMENT Inability to Place Catheter ?PHONE CALL Questions Orders Degree of Urgency ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Airway and Vital Signs Selective History and Chart Review Selective Physical Examination MANAGEMENT Gross Hematuria ?REMEMBER GASTROINTESTINAL DECOMPRESSION TUBES Indications Contraindications and Precautions Equipment Needed Anatomy/Approach Anesthesia Placement Complications of Nasogastric Tubes Problems with Nasogastric Tubes Blocked Nasogastric Tube ?PHONE CALL Questions Orders Degree of Urgency ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Airway and Vital Signs MANAGEMENT Dislodged Nasogastric Tube ?PHONE CALL Questions Degree of Urgency ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE Hypoglycemia ?BEDSIDE Quick Look Test Airway and Vital Signs MANAGEMENT ?REMEMBER BILIARY DRAINAGE TUBES (T-TUBES) Blocked T-Tube ?PHONE CALL Questions Orders Degree of Urgency ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Airway and Vital Signs MANAGEMENT Dislodged T-Tube ?PHONE CALL Questions Orders Degree of Urgency ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Airway and Vital Signs MANAGEMENT WOUND DRAINAGE TUBES (Penrose, Jackson-Pratt, Blake, and Davol) Problems With Wound Drainage Tubes Blocked Wound Drainage Tube ?PHONE CALL Questions Orders Degree of Urgency ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Airway and Vital Signs MANAGEMENT Agents Used in Pleurodesisa Dislodged Wound Drainage Tube ?PHONE CALL Questions Orders Degree of Urgency ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE BEDSIDE Quick Look Test Airway and Vital Signs MANAGEMENT 32 - Point-of-Care and Procedural Ultrasound: For Surgical Residents BASIC PHYSICS ULTRASOUND WAVES THE PROBES THE MACHINE Common Modes, Buttons, and Dials Image Presets Depth Gain M-Mode Doppler Imaging SAFETY ERGONOMICS GETTING AN IMAGE COMMON ARTIFACTS THAT AFFECT INTERPRETATION Basic Ultrasound Imaging Artifacts Mirroring Shadowing Refraction BEDSIDE EXAMINATIONS E-FAST RUQ View LUQ View Cardiac View Pelvis View Thorax (Lung Sliding) E-FAST in Clinical Decision Making E-FAST in Unstable Penetrating Trauma E-FAST in Unstable Blunt Trauma E-FAST in Stable Blunt Trauma The “Educational” E-FAST Examination SPECIAL CONSIDERATIONS—PEDIATRIC FAST EXAMINATION BEDSIDE CARDIAC ASSESSMENT (ICU) Evaluation for Pericardial Effusion/Tamponade Volume Assessment Using The IVC Gross Measurements of Overall Cardiac Function SUPERFICIAL ABSCESS EVALUATION BLADDER VOLUME HEMATOMA VERSUS PSEUDOANEURYSM PROCEDURAL ULTRASOUND Arterial Line Central Line Aspiration (Breast, Fluid Collection) 33 - Urine Output Changes DECREASED URINE OUTPUT ?PHONE CALL Questions Orders Degree of Urgency ?ELEVATOR THOUGHTS MAJOR THREAT TO LIFE Surgical Chart Biopsy ?BEDSIDE Quick Look Test Airway and Vital Signs Initial Management Selective History and Chart Review MANAGEMENT Pre-Renal Fluid Deficit Normal or Increased Fluid Status Postrenal Renal SPECIAL SURGICAL CONSIDERATIONS Preoperative Considerations Postoperative Considerations ?REMEMBER INCREASED URINE OUTPUT ?PHONE CALL Questions Orders Degree of Urgency ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE SURGICAL CHART BIOPSY ?BEDSIDE Quick Look Test Airway and Vital Signs Initial Management Selective History and Chart Review MANAGEMENT SPECIAL SURGICAL CONSIDERATIONS Preoperative Considerations POSTOPERATIVE CONSIDERATIONS HEMATURIA PHONE CALL Questions Orders For Significant Bleeding If Urinary Obstruction Is Present Degree of Urgency ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE Surgical Chart Biopsy ?BEDSIDE Quick Look Test Airway and Vital Signs Initial Management Selective History and Chart Review Selective Physical Examination MANAGEMENT SPECIAL SURGICAL CONSIDERATIONS Preoperative Considerations Postoperative Considerations ?REMEMBER 34 - Wounds ?PHONE CALL Questions Orders Informing the RN Surgical Chart Biopsy ?ELEVATOR THOUGHTS ?MAJOR THREAT TO LIFE ?BEDSIDE Quick Look Test Airway and Vital Signs Selective History and Chart Review Selective Physical Examination MANAGEMENT Erythematous Wounds Rapid-Onset Cellulitis Invasive or Gangrenous Wound Infection Necrotizing Fasciitis Wound Swelling Draining Wounds Wounds With Exposed Deep Structures Wound Dehiscence or Evisceration Superficial Wounds Actively Bleeding Wounds A - Reading X-Rays, Reading ECGs Reading X-Rays (Fig. A.1 and A.2) Reading ECGs RATE RHYTHM AXIS P WAVE CONFIGURATION Left Atrial Enlargement (Fig. A.5B) Right Atrial Enlargement (Fig. A.5C) QRS CONFIGURATION Left Ventricular Hypertrophy Right Ventricular Hypertrophy CONDUCTION ABNORMALITIES First-Degree Block Second-Degree Block Third-Degree Block VENTRICULAR PREEXCITATION B - Outlines of Common Surgical Notes Brief OP Note Post-OP Check On-Call/Cross-Coverage Note C - Abbreviations Index A B C D E F G H I J K L M N O P Q R S T U V W Z IBC