By Lawrence W. Way
College of California, San Francisco. Lange clinical ebook sequence. new version of a Brandon/Hill scientific checklist first-purchase choice. Reference on ailments controlled by way of surgeons, for clinical scholars, citizens, and practitioners. 88 participants, eighty five U.S.
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Additional info for Current Surgical Diagnosis and Treatment
Specific Factors Affecting Operative Risk A. The Compromised or Altered Host Patients may be considered compromised or altered hosts if significant impairment of systems and tissues does not permit a normal response to operative trauma or infection. Preoperative recognition of an abnormal nutritional or immune state is of obvious importance. 1. Nutritional Assessment—It has long been documented that malnutrition leads to a significant increase in the operative death rate. Weight loss of more than 20% caused by illness such as cancer or intestinal disease not only results in a higher death rate but also a greater than threefold increase in the postoperative infection rate.
When used prophylactically, drains are usually placed in a sterile location. Strict precautions must be taken to prevent bacteria from entering the body through the drainage tract in these situations. The external portion of the drain must be handled with aseptic technique, and the drain must be removed as soon as it is no longer useful. When drains have been placed in an infected area, there is a smaller risk of retrograde infection of the peritoneal cavity, since the infected area is usually walled off.
Preoperative evaluation includes at least a complete history and physical examination. Patients over 40 should also have complete blood counts and serum electrolyte measurements. Patients over 50 should have chest x-rays and electrocardiograms as well. Open wounds and infections usually require culture and determination of antibiotic sensitivity. Surface cultures of open wounds are usually of little help, particularly when closure of the wound with a skin graft is contemplated or primary closure will be allowed to occur.
Current Surgical Diagnosis and Treatment by Lawrence W. Way