Download e-book for iPad: Washington Manual of Surgery, 4th Edition by Klingensmith, Mary E.; Amos, Keith D.; Green, Douglas W.;

By Klingensmith, Mary E.; Amos, Keith D.; Green, Douglas W.; Halpin, Valerie J.; Hunt, Steven R.

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Pulmonary complications ◊ The differential diagnosis of dyspnea includes atelectasis, pneumonia, CHF, COPD or asthma exacerbation, pneumothorax, PE, and aspiration. ◊ Evaluation ⋅ History. Additional factors that help to differentiate disease entities include the presence of a fever, chest pain, and the time since surgery. ⋅ Physical examination with attention to jugular venous distention, breath sounds (wheezing, crackles), symmetry, and respiratory effort. ⋅ Diagnostic testing • Laboratory.

If the patient has generalized peritonitis, emergency laparotomy is indicated. If the inflammation appears to be localized, a CT scan of the patient's abdomen and pelvis should be obtained. The primary management of an intraabdominal abscess is drainage. In some circumstances, this can be performed percutaneously with radiologic guidance. In other situations, operative débridement and drainage are required. Empiric antibiotic therapy should cover enteric pathogens and anaerobes. 36 37 ⋅ Genitourinary infections.

This occurs most often in elderly nonâ insulin-dependent diabetes mellitus patients with renal impairment and may be precipitated by surgical illness or stress. Laboratory findings include blood glucose that exceeds 600 mg/dL and serum osmolarity of more than 350 mOsm/L. 45% saline, and (2) total insulin requirements are less. ♦ Hypertension ◊ Definition. Postoperative hypertension should be defined by the patient's preoperative blood pressure. Patients with chronic hypertension have a shift in their cerebral autoregulatory system that may not allow for adequate cerebral perfusion at normotensive blood pressures.

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