Information ⬇
- Re-evaluation and optimization of the circulation, oxygenation, temperature, central nervous system function, coagulation, electrolyte and acid–base status, and renal function are the hallmarks of postoperative management.
- Pain control improves pulmonary function, ventilation, and oxygenation in patients with chest injuries or long abdominal incisions.
- Acute renal failure is a possibility if prolonged shock or crush syndrome occur during early management. The cause of renal failure in crush syndrome is probably rhabdomyolysis-induced myoglobin release into the circulation. The traditional prophylaxis for renal failure after rhabdomyolysis includes fluids, mannitol, and bicarbonate. (Recent data suggest that bicarbonate and mannitol are ineffective.)
- Abdominal compartment syndrome results from intra-abdominal hypertension with organ dysfunction after major abdominal trauma and surgery (Fig. 52-6: Physiologic effects of abdominal compartment syndrome).
- Clinically, a tense, severely distended abdomen; raised peak airway pressure; CO2 retention; and oliguria should direct the clinician to measure the intravesical pressure via a Foley catheter, which reflects the intra-abdominal pressure.
- Values >20 to 25 mm Hg may indicate inadequate organ perfusion and necessitate abdominal decompression, which, if delayed, may result in progression to multiorgan failure and death.
- Thromboembolism
- In most instances, DVT is asymptomatic, and in many of those in whom leg swelling develops, concurrent lower extremity injuries may be implicated.
- The diagnosis of proximal DVT in symptomatic patients can be made by duplex ultrasonography, but this method has low sensitivity in the absence of symptoms.
- Venography, which is the gold standard, can be performed in equivocal cases, but it is associated with complications and inherent logistical problems.
Outline ⬆