版权说明：本文档由用户提供并上传，收益归属内容提供方，若内容存在侵权，请进行举报或认领
文档简介
PerioperativeManagementPerioperativeManagementPerioperativePeriodDefinitiondependsonmultiplefactorsImportancedirectlyrelatedtotheoutcomeofsurgeryitselfCompositionpreoperativepreparation&postoperativemanagementPerioperativePeriodDefinition
1.Electivesurgery2.Restrictivesurgery3.EmergentsurgeryPreoperativePreparationTheprincipleDifferentpreparationfordifferentproceduresTheclassificationofoperationsaccordingtothecharacteristicsofoperationsElectivesurgeryRestrictivesurgeryEmergentsurgery1.ElectivesurgeryPreoperativElectiveSurgeryElectiveSurgeryRestrictiveSurgeryRestrictiveSurgeryEmergentSurgeryEmergentSurgeryDr.EvilSays….$$$$????Dr.EvilSays….$$$$TheodorKocher(1841-1917)WithTheodorBillrothestablishedlargeclinicsinEuropeand,throughdevelopmentofskilledsurgicaltechniquescombinedwithneweranestheticandantisepticprinciples,providedsurgicalresultsthatprovedthesafetyandefficacyofthyroidsurgeryforbenignandmalignantproblemsTheodorKocher(1841-1917)WitWilliamStewartHalsted(1852-1922)ASCENTOFSCIENTIFICSURGERYResearchbasedonanatomic,pathologic,andphysiologicprinciplesandemployinganimalexperimentationHalstedianprinciples
WilliamStewartHalsted(1852-ToconfirmthediagnosisToassesstheriskofoperationToassessthegeneralconditionandfunctionofimportantorgansToevaluatethepatientsendurancetotheoperationandriskofoperationPreoperativeAssessmentToconfirmthediagnosisPreoEssentialStepsHistorytakingPhysicalexaminationArranginganyfurtherdiagnosticinvestigationMakingspecialpreparationsfortheparticularoperationInvestigatinganyintercurrentoroccultillnesssuggestedbymedicalclerkingEssentialStepsHistorytakingEssentialStepsDiscussingtheoperationwiththepatientandhisfamilyandobtainingsignedconsentMarkingtheoperationsiteMakingarrangementsfortheoperationwiththeoperatingtheatrestaffArrangingandinformingtheanesthetistsPrescribingmedication:prophylacticantibioticsetc.PlanningrehabilitationandconvalescenceEssentialStepsDiscussingthePsychologicalpreparation
talkfranklyandappropriatelytopatientsandfamiliesPhysiologicalpreparationAdaptiveexerciseTransfusionPreventionofinfectionGastro-intestinaltractpreparationMaintenanceoffluid,electrolytesandnutritionGeneralPreparationPsychologicalpreparationAdaMalnutritionanddysfunctionofimmunesystem
MalnutritiondramaticallyincreasesthemorbidityandmortalityPreoperativenutritionalsupportismorevaluableSpecificPreparationMalnutritionanddysfunctionoHypertension
Mild-to-moderateessentialhypertension
systolicpressure＜180mmHg
diastolicpressure＜110mmHg
Atminimalriskofcardiaccomplication
AntihypertensivedrugsshouldbeusedalltimeSuddenwithdrawalofdrugsisdangerousHypertensionMild-to-moderaSevereorPoorlyControlledHypertensionAthighriskofperioperativecardiacfailureorstroke.Thistypeofpatientsshouldnotundergogeneralanaesthesiaandsurgeryuntiladequatelytreated.Thebloodpressureshouldbereasonablycontrolledunder160/100mmHg.SevereorPoorlyControlledHyCardiovascularDiseasesIschemicheartdiseaseCardiacfailureArrhythmiasValvularheartdiseaseCerebrovasculardiseaseCardiovascularDiseasesIscheAnginaandPreviousInfarctionPreviousinfarctionStableanginaposeslittleincreasedriskduringoperationbutunstableanginaisasdangerousasrecentmyocardialinfarctionTheriskofreinfarctionisabout30%ifanoperationisperformedduringthefirst3monthsAt6monthstheriskisabout10~15%whichmaybeacceptableforimportantelectivesurgeryAnginaAnginaandPreviousInfarctionAdequatePreparationforHeartDiseaseTocorrectthefluidandelectrolytesimbalance.Tocorrectanaemiathroughseveralbloodtransfusionwithsmallamount.Tocontrolthecardiacarrhythmias.(Atrialfibrillation,Tachycardia,Bradycardia)AdequatePreparationforHeartRespiratorydysfunctionRespiratorycomplicationsoccurinupto15%ofsurgicalpatientsandaretheleadingcauseofpostoperativemortalityintheelderly.RespiratorydysfunctionRespiraRiskFactorsforRespiratoryComplicationChronicobstructivepulmonaryorairwaysdiseaseChronicbronchitis,emphysema,bronchiectasis,pneumoconiosis,pulmonarytuberculosesCigarettesmokingCurrentrespiratoryinfectionsAsthmaRiskFactorsforRespiratoryCPreoperativeInvestigationAchestX-rayCTscanifnecessaryEKGSpirometerBloodgasmeasurementPreoperativeInvestigationAPerioperativemanagement`PreoperativephysiotherapyteachingthepatientbreathingexercisesandcorrectpostureDrugtherapyTheophyllinesProphylacticantibioticsPreoperativebronchodilatorAdequatehydrationPerioperativeManagementPerioperativemanagement`PreopEncouragetostopsmokingfromthetimeofbookforelectivesurgeryAlternationmethodsofanesthesia
Local,regionalorspiralanesthesiashouldbeconsideredEarlypostoperativephysiotherapy
toenhancedeepbreathing,coughingandgeneralmobility
PerioperativeManagementEncouragetostopsmokingfromLiverDisorderThetolerancetooperationdependsupontheseverityofliverfunctionimpairment.TheliverfunctioncouldbeestimatedbyChildstagingorMELDscoreMalnutrition,ascitesandjaundicearecontraindicationsexceptforemergencysurgery.
LiverDisorderThetolerancePreoperativeAssessmentandManagementHBVandHCV,CBCClottingscreenandplateletcountElectrolytesLiverandrenalfunctionWhenprothrombintimeisprolonged,vitaminKshouldbegivenforseveraldaysbeforeoperation.PreoperativeAssessmentandMaRenalDisordersPreoperativeassessmentplasmaurea,electrolytes,creatinineandBicarbonateshouldbecheckedMildchronicrenalfailure
DrugsshouldbegiveninsmallerdosesFluidandelectrolytehomeostasisModerate-to-severechronicrenalfailure
Operationsshouldbeperformedunderhaemodialysis
RenalDisordersPreoperativeasDiabetesMellitusAtspecialriskfromgeneralanesthesiaandsurgery
Patientswithdiabetesfallintothreegroups1.Insulindependent2.Takingoralhypoglycaemicmedication3.Diet-controlledDiabetesMellitusAtspeciaAttempttomaintainbloodglucoselevelbetween4and10mmol/Lavoidhypoglycemiainparticular.Bloodglucoselevel＞13mmol/LAnunreceptibleriskofketoacidosisorahyperosmolarnon-ketoticstate.PerioperativeManagementAttempttomaintainbloodglEstablishgooddiabeticcontrolbeforeoperationGiveninsulinasacontinuousintravenousinfusionduringtheoperativeperiodGivenaninfusionofdextrosethroughouttheoperativeperiodtobalancetheinsulingivenandtomakeupforlackofdietaryintakePerioperativeManagementEstablishgooddiabeticcontroPatientswithdiabetes:
whatpre-operativeassessmentisimportant?DocumentthefollowingTypeofdiabetesLengthoftimesincediagnosisCurrentmanagementCurrentglycemiccontrolHgBA1cGlucometerdtaPresenceofcomplicationsNeuropathyNephropathyRetinopathyAutonomicneuropathyincreaseriskofpostopgastroparesisandurinarytractinfectionPatientswithdiabetes:
whatp外科学教学课件：PerioperativeManagementPerioperativeanagementAddpotassiumtothedextroseinfusionMonitorbloodglucoseandelectrolytesfrequentlythroughouttheoperativeandearlypostoperativeperiodPerioperativeanagementAddpot
Recoveryroomisnecessary
ICUisoptimalifpossibleMonitoring
CloselymonitorthelifesignsasaroutineCVPmonitoringisnecessaryifhemodynamicunstableduringoperationOtheritemsmonitoredaccordinglyFluidbalancePost-operativeManagementRecoveryroomisnecesPositionandGetting-upSupinepositionforspiralanaesthesiaSemirecliningpositionforneckandchestoperation.Lateralpositionforobesitypatients.GetupasearlyaspossibleandmakemovementsasmuchaspossiblePositionandGetting-upSupinDietandTransfusionPeriodoffastdependsuponthetypeofoperation.Enteralandparenteralnutritionshouldbetakenintoconsideration.Fluidandelectrolyteshomeostasisshouldbemaintained.DietandTransfusionPeriodoManagementofDrainageDifferentdrainagefordifferentpurpose(infectionfocus,leakagepreventionandmassiveexudation)Nasal-gastrictubeUrinarycatheterManagementofDrainageDiffere外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagementWoundHealingandSutureRemovingClassificationofincision
cleanincisioncontaminatedincisioninfectedincisionTypeofhealing
TypeAperfecthealingBsomeinflammationCinfectedWoundHealingandSutureRemovPostoperativepain
anymotionsincreasingtensionswillincreasepainAnalgesiaisobligatoryPyrexia
commonpostoperativeobservationasearchbemadeforafocusofinfectionnon-infectivecausesofpyrexiaManagementofPostoperativeComplaintsPostoperativepainManagementoNauseaandVomitingDrugsopiates,antibiotics,metronidazoleBowelobstructionmechanicalobstructionAdynamicbowelHypokalaemiafaecalimpactionSystemicdisorderselectrolytedisturbancesUraemiaraisedintracranialpressureNauseaandVomitingDrugsAbdominalDistensionMorecommonafterabdominalsurgeryHiccupDiaphragmirritationorcentralnervoussystemstimulatedSubphrenicinfectionshouldbesuspectedforcontinuoushiccupAbdominalDistensionMorecommoRetentionofUrineThereisapalpablesuprapubicmasswithdulltopercussion.Urinarycatheterisindicatedwhendiagnosed.RetentionofUrineThereisaThemainpostoperativecomplicationsAtelectasisChestinfectionAspirationpneumonitisPneumoniaThemainpostoperativecomplicPostoperativeHaemorrhageCausesinadequateoperativehaemostasisatechnicalmishapasslippedligatureManagementre-operationtostopbleedingsomepreparationisnecessaryPostoperativecomplicationsPostoperativeHaemorrhageCauseWoundDehiscence(BurstAbdomen)Causesbloodsupplyispoorexcesssuturetensionlong-termsteroidtherapyimmunosuppressivetherapymalnutritioninfectioncoughingorabdominaldistensionManagementre-suturingwithtensionsuturesthewholethicknessoftheabdominalwallWoundDehiscence(BurstAbdomeMinorwoundinfectionslocalizedpain,rednessandaslightdischargeWoundCellulitisandAbscesscellulitistreatedbyantibioticsabscesstreatedbysurgical drainage
WoundInfectionMinorwoundinfectionsWoundIn外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagementAtelectasis
AirwayobstructedairisabsorbedfromtheairspacesdistaltotheobstructionBronchialsecretionsarethemainPreventionandtreatment
perioperativephysiotherapyisthebestwayforpreventiondeepbreathingexercisesregularadjustmentsofposturevigorouscoughingflexiblebronchoscopytoaspirateoccludingmucusplugsAtelectasisAirwayobstructedUrinaryTractInfectionsCausesreducedurinaryoutputreducing“flushing”ofbladderincompletebladderemptyinginadequateperinealhygieneTreatment
ensuringadequatefluidinputappropriateantibioticsUrinaryTractInfectionsCausesCauses
bedboundafteroperationvenousstasisplasmaconcentratedduedehydrationviscosityincreasedManifestationsswellingofthelegtendernessofthecalfmuscleincreasedwarmthofthelegcalfpainonpassivedorsiflexionofthefootDeepVeinThrombosisCausesbedboundafteroTreatment
Anticoagulation:
Systemicthrombolytictherapy:
streptokinaseLocalthrombolyticdrugsismorepromisingintravenousheparinsubcutaneousheparinoralwarfarintherapyDeepVeinThrombosisTreatmentintravenousheparinDepostoperativemobilizationadequatehydrationavoidingcalfpressurePreventionHighRiskCaseslowdosesubcutaneousheparincalfcompressiondevicesgraded-compression‘anti-embolism’stockingsIntravenousdextranWarfarinanticoagulationDeepVeinThrombosispostoperativemobilizationPSamplePreoperativeChecklistOperativepermit,appropriatelysignedandwitnessedDietaryconsiderationsForabdominaloperation,liquiddietandlaxativestoensureclean,collapsedbowelNothingbymouthatleast6hrbeforeoperationSamplePreoperativeChecklistReviewoflife-supportsystemsVitalsignsrecordedoftenenoughtoestablishnormalvaluesPulmonarysystem:chestfilms;OtherstudiesasindicatedCardiacfunction:electrocardiogram;OtherstudiesasindicatedSamplePreoperativeChecklistReviewoflife-supportsystemsRenalfunction:urinalysis;BloodureanitrogenandpossiblybloodcreatininedeterminationsAdequatehydrationuptotimeofoperation,especiallytocompensateforlaxativesandfastingAreaofoperationwashedwithappropriategermicidaldetergentandshaved,clipped,orcleansedwithdepilatoryagentBloodtransfusionspreparedasanticipatedSamplePreoperativeChecklistRenalfunction:SamplePreoperaOrderforpatienttovoidoncalltooperatingroomPreoperativemedications:vagolyticandsedativedrugsSpecialmedications:digitalis,insulin,etc.SamplePreoperativeChecklistOrderforpatienttovoidoncFast—trackrehabilitationinsurgery(外科快速康复方法)Enhancedrecoveryaftersurgery(促进外科手术后康复程序)Fast-trackSurgeryFast—trackrehabilitationinsSurgeonsNamedNobelLaureates
inMedicineandPhysiologySurgeon(Dates)
Country
Field(YrofAward)
TheodorKocher(1841-1917)AllvarGullstrand(1862-1930)AlexisCarrel(1873-1944)RobertBarany(1876-1936)FrederickBanting(1891-1941)WalterHess(1881-1973)WernerForssmann(1904-1979)CharlesHuggins(1901-1997)JosephMurray(born1919)SwitzerlandSwedenFranceandU.S.AAustriaCanadaSwitzerlandGermanyUnitedStatesUnitedStatesThyroiddisease(1909)Oculardioptrics(1911)Vascularsurgery(1912)Vestibulardisease(1914)Insulin(1922)Midbrainphysiology(1949)Cardiaccatheterization(1956)Oncology(1966)Organtransplantation(1990)SurgeonsNamedNobelLaureatesQuestions?Questions?ThankYou!ThankYou!PerioperativeManagementPerioperativeManagementPerioperativePeriodDefinitiondependsonmultiplefactorsImportancedirectlyrelatedtotheoutcomeofsurgeryitselfCompositionpreoperativepreparation&postoperativemanagementPerioperativePeriodDefinition
1.Electivesurgery2.Restrictivesurgery3.EmergentsurgeryPreoperativePreparationTheprincipleDifferentpreparationfordifferentproceduresTheclassificationofoperationsaccordingtothecharacteristicsofoperationsElectivesurgeryRestrictivesurgeryEmergentsurgery1.ElectivesurgeryPreoperativElectiveSurgeryElectiveSurgeryRestrictiveSurgeryRestrictiveSurgeryEmergentSurgeryEmergentSurgeryDr.EvilSays….$$$$????Dr.EvilSays….$$$$TheodorKocher(1841-1917)WithTheodorBillrothestablishedlargeclinicsinEuropeand,throughdevelopmentofskilledsurgicaltechniquescombinedwithneweranestheticandantisepticprinciples,providedsurgicalresultsthatprovedthesafetyandefficacyofthyroidsurgeryforbenignandmalignantproblemsTheodorKocher(1841-1917)WitWilliamStewartHalsted(1852-1922)ASCENTOFSCIENTIFICSURGERYResearchbasedonanatomic,pathologic,andphysiologicprinciplesandemployinganimalexperimentationHalstedianprinciples
WilliamStewartHalsted(1852-ToconfirmthediagnosisToassesstheriskofoperationToassessthegeneralconditionandfunctionofimportantorgansToevaluatethepatientsendurancetotheoperationandriskofoperationPreoperativeAssessmentToconfirmthediagnosisPreoEssentialStepsHistorytakingPhysicalexaminationArranginganyfurtherdiagnosticinvestigationMakingspecialpreparationsfortheparticularoperationInvestigatinganyintercurrentoroccultillnesssuggestedbymedicalclerkingEssentialStepsHistorytakingEssentialStepsDiscussingtheoperationwiththepatientandhisfamilyandobtainingsignedconsentMarkingtheoperationsiteMakingarrangementsfortheoperationwiththeoperatingtheatrestaffArrangingandinformingtheanesthetistsPrescribingmedication:prophylacticantibioticsetc.PlanningrehabilitationandconvalescenceEssentialStepsDiscussingthePsychologicalpreparation
talkfranklyandappropriatelytopatientsandfamiliesPhysiologicalpreparationAdaptiveexerciseTransfusionPreventionofinfectionGastro-intestinaltractpreparationMaintenanceoffluid,electrolytesandnutritionGeneralPreparationPsychologicalpreparationAdaMalnutritionanddysfunctionofimmunesystem
MalnutritiondramaticallyincreasesthemorbidityandmortalityPreoperativenutritionalsupportismorevaluableSpecificPreparationMalnutritionanddysfunctionoHypertension
Mild-to-moderateessentialhypertension
systolicpressure＜180mmHg
diastolicpressure＜110mmHg
Atminimalriskofcardiaccomplication
AntihypertensivedrugsshouldbeusedalltimeSuddenwithdrawalofdrugsisdangerousHypertensionMild-to-moderaSevereorPoorlyControlledHypertensionAthighriskofperioperativecardiacfailureorstroke.Thistypeofpatientsshouldnotundergogeneralanaesthesiaandsurgeryuntiladequatelytreated.Thebloodpressureshouldbereasonablycontrolledunder160/100mmHg.SevereorPoorlyControlledHyCardiovascularDiseasesIschemicheartdiseaseCardiacfailureArrhythmiasValvularheartdiseaseCerebrovasculardiseaseCardiovascularDiseasesIscheAnginaandPreviousInfarctionPreviousinfarctionStableanginaposeslittleincreasedriskduringoperationbutunstableanginaisasdangerousasrecentmyocardialinfarctionTheriskofreinfarctionisabout30%ifanoperationisperformedduringthefirst3monthsAt6monthstheriskisabout10~15%whichmaybeacceptableforimportantelectivesurgeryAnginaAnginaandPreviousInfarctionAdequatePreparationforHeartDiseaseTocorrectthefluidandelectrolytesimbalance.Tocorrectanaemiathroughseveralbloodtransfusionwithsmallamount.Tocontrolthecardiacarrhythmias.(Atrialfibrillation,Tachycardia,Bradycardia)AdequatePreparationforHeartRespiratorydysfunctionRespiratorycomplicationsoccurinupto15%ofsurgicalpatientsandaretheleadingcauseofpostoperativemortalityintheelderly.RespiratorydysfunctionRespiraRiskFactorsforRespiratoryComplicationChronicobstructivepulmonaryorairwaysdiseaseChronicbronchitis,emphysema,bronchiectasis,pneumoconiosis,pulmonarytuberculosesCigarettesmokingCurrentrespiratoryinfectionsAsthmaRiskFactorsforRespiratoryCPreoperativeInvestigationAchestX-rayCTscanifnecessaryEKGSpirometerBloodgasmeasurementPreoperativeInvestigationAPerioperativemanagement`PreoperativephysiotherapyteachingthepatientbreathingexercisesandcorrectpostureDrugtherapyTheophyllinesProphylacticantibioticsPreoperativebronchodilatorAdequatehydrationPerioperativeManagementPerioperativemanagement`PreopEncouragetostopsmokingfromthetimeofbookforelectivesurgeryAlternationmethodsofanesthesia
Local,regionalorspiralanesthesiashouldbeconsideredEarlypostoperativephysiotherapy
toenhancedeepbreathing,coughingandgeneralmobility
PerioperativeManagementEncouragetostopsmokingfromLiverDisorderThetolerancetooperationdependsupontheseverityofliverfunctionimpairment.TheliverfunctioncouldbeestimatedbyChildstagingorMELDscoreMalnutrition,ascitesandjaundicearecontraindicationsexceptforemergencysurgery.
LiverDisorderThetolerancePreoperativeAssessmentandManagementHBVandHCV,CBCClottingscreenandplateletcountElectrolytesLiverandrenalfunctionWhenprothrombintimeisprolonged,vitaminKshouldbegivenforseveraldaysbeforeoperation.PreoperativeAssessmentandMaRenalDisordersPreoperativeassessmentplasmaurea,electrolytes,creatinineandBicarbonateshouldbecheckedMildchronicrenalfailure
DrugsshouldbegiveninsmallerdosesFluidandelectrolytehomeostasisModerate-to-severechronicrenalfailure
Operationsshouldbeperformedunderhaemodialysis
RenalDisordersPreoperativeasDiabetesMellitusAtspecialriskfromgeneralanesthesiaandsurgery
Patientswithdiabetesfallintothreegroups1.Insulindependent2.Takingoralhypoglycaemicmedication3.Diet-controlledDiabetesMellitusAtspeciaAttempttomaintainbloodglucoselevelbetween4and10mmol/Lavoidhypoglycemiainparticular.Bloodglucoselevel＞13mmol/LAnunreceptibleriskofketoacidosisorahyperosmolarnon-ketoticstate.PerioperativeManagementAttempttomaintainbloodglEstablishgooddiabeticcontrolbeforeoperationGiveninsulinasacontinuousintravenousinfusionduringtheoperativeperiodGivenaninfusionofdextrosethroughouttheoperativeperiodtobalancetheinsulingivenandtomakeupforlackofdietaryintakePerioperativeManagementEstablishgooddiabeticcontroPatientswithdiabetes:
whatpre-operativeassessmentisimportant?DocumentthefollowingTypeofdiabetesLengthoftimesincediagnosisCurrentmanagementCurrentglycemiccontrolHgBA1cGlucometerdtaPresenceofcomplicationsNeuropathyNephropathyRetinopathyAutonomicneuropathyincreaseriskofpostopgastroparesisandurinarytractinfectionPatientswithdiabetes:
whatp外科学教学课件：PerioperativeManagementPerioperativeanagementAddpotassiumtothedextroseinfusionMonitorbloodglucoseandelectrolytesfrequentlythroughouttheoperativeandearlypostoperativeperiodPerioperativeanagementAddpot
Recoveryroomisnecessary
ICUisoptimalifpossibleMonitoring
CloselymonitorthelifesignsasaroutineCVPmonitoringisnecessaryifhemodynamicunstableduringoperationOtheritemsmonitoredaccordinglyFluidbalancePost-operativeManagementRecoveryroomisnecesPositionandGetting-upSupinepositionforspiralanaesthesiaSemirecliningpositionforneckandchestoperation.Lateralpositionforobesitypatients.GetupasearlyaspossibleandmakemovementsasmuchaspossiblePositionandGetting-upSupinDietandTransfusionPeriodoffastdependsuponthetypeofoperation.Enteralandparenteralnutritionshouldbetakenintoconsideration.Fluidandelectrolyteshomeostasisshouldbemaintained.DietandTransfusionPeriodoManagementofDrainageDifferentdrainagefordifferentpurpose(infectionfocus,leakagepreventionandmassiveexudation)Nasal-gastrictubeUrinarycatheterManagementofDrainageDiffere外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagementWoundHealingandSutureRemovingClassificationofincision
cleanincisioncontaminatedincisioninfectedincisionTypeofhealing
TypeAperfecthealingBsomeinflammationCinfectedWoundHealingandSutureRemovPostoperativepain
anymotionsincreasingtensionswillincreasepainAnalgesiaisobligatoryPyrexia
commonpostoperativeobservationasearchbemadeforafocusofinfectionnon-infectivecausesofpyrexiaManagementofPostoperativeComplaintsPostoperativepainManagementoNauseaandVomitingDrugsopiates,antibiotics,metronidazoleBowelobstructionmechanicalobstructionAdynamicbowelHypokalaemiafaecalimpactionSystemicdisorderselectrolytedisturbancesUraemiaraisedintracranialpressureNauseaandVomitingDrugsAbdominalDistensionMorecommonafterabdominalsurgeryHiccupDiaphragmirritationorcentralnervoussystemstimulatedSubphrenicinfectionshouldbesuspectedforcontinuoushiccupAbdominalDistensionMorecommoRetentionofUrineThereisapalpablesuprapubicmasswithdulltopercussion.Urinarycatheterisindicatedwhendiagnosed.RetentionofUrineThereisaThemainpostoperativecomplicationsAtelectasisChestinfectionAspirationpneumonitisPneumoniaThemainpostoperativecomplicPostoperativeHaemorrhageCausesinadequateoperativehaemostasisatechnicalmishapasslippedligatureManagementre-operationtostopbleedingsomepreparationisnecessaryPostoperativecomplicationsPostoperativeHaemorrhageCauseWoundDehiscence(BurstAbdomen)Causesbloodsupplyispoorexcesssuturetensionlong-termsteroidtherapyimmunosuppressivetherapymalnutritioninfectioncoughingorabdominaldistensionManagementre-suturingwithtensionsuturesthewholethicknessoftheabdominalwallWoundDehiscence(BurstAbdomeMinorwoundinfectionslocalizedpain,rednessandaslightdischargeWoundCellulitisandAbscesscellulitistreatedbyantibioticsabscesstreatedbysurgical drainage
WoundInfectionMinorwoundinfectionsWoundIn外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科
温馨提示
- 1. 本站所有资源如无特殊说明，都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
- 2. 本站的文档不包含任何第三方提供的附件图纸等，如果需要附件，请联系上传者。文件的所有权益归上传用户所有。
- 3. 本站RAR压缩包中若带图纸，网页内容里面会有图纸预览，若没有图纸预览就没有图纸。
- 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
- 5. 人人文库网仅提供信息存储空间，仅对用户上传内容的表现方式做保护处理，对用户上传分享的文档内容本身不做任何修改或编辑，并不能对任何下载内容负责。
- 6. 下载文件中如有侵权或不适当内容，请与我们联系，我们立即纠正。
- 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。
最新文档
- 职业病危害因素识别与防治考核试卷
- 禽类屠宰设备性能提升与优化考核试卷
- 网络安全防护在智慧能源的分布式能源系统中评估考核试卷
- 聚环氧乙烷纤维的可持续性评估考核试卷
- 羽绒制品行业人才培养与技能提升考核试卷
- 物流设备绿色制造与回收考核试卷
- 木竹浆生产过程中安全生产管理考核试卷
- 老年人合法权益维护考核试卷
- 索道施工过程中的质量控制体系考核试卷
- 科技创新趋势的未来挑战与应对策略考核试卷
- 财务英文词汇大全
- 年产吲哚美辛的生产设计设计说明书
- QD型吊钩桥式起重机使用维护说明书
- 新高考：地理选科指导
- 各种变频器的使用说明书.lg-ig53parameter list
- GB/T 19582.2-2008基于Modbus协议的工业自动化网络规范第2部分：Modbus协议在串行链路上的实现指南
- 细胞的能量“货币”ATP说课课件-高一上学期生物人教版必修1
- 解剖学课件神经系统课件
- 印巴战争（修改稿）
- 工程项目管理实施方案(5篇)
- 2021年全国质量奖现场汇报材料-基础设施、设备及设施管理过程课件
评论
0/150
提交评论