The patient in discussion is an eighty five year old female who had undergone exploratory laparotomy. This author first encountered the patient during post-operative day five. On this day, the patient was progressing well; tolerating diet, ambulating hallways, vitals stable, abdominal incision approximated, and pain controlled. Patient was looking forward to being discharged back home in a few days. After returning to the unit after a few days off, I cared for the same patient on post-operative day 8. Upon assessing, the patient findings included; patient needed oxygen to ambulate to the bathroom and appeared very short of breath, low urine output, lungs with crackles throughout, low-grade temperature, brown drainage from abdominal incision
Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.
The patient did have black soot around his nose and mouth. Thats when first responders started manual ventilation's via BVM and 02 at 15 LPM. At this time Medic 1 assumed patient care. Medic 1 assigned first responders to obtaining vitals signs that are stated in the vital section of the report. It was at this time that Medic 1 applied a OPA after first measuring on what size to use. First responders also applied fast patches to the patients right upper chest and left midaxillary line At this time Medic 1 assigned first responders to start chest compressions a 15:2 ratio. Medic 1 at this time started a IO in the patients plateau region of the right leg. The Plateau region is inferior and lateral to the knee cap. At this time Normal Saline bolus was started with a 60 drop per ML set. Medic 1 found the patient to be in a sinus rhythm At this time miscommunication with Medic 1 and first responders happen with chest comparisons started. We then secured the patient on the cot via 4 straps and transported a code red patient to the nearest hospital. While enroute to hospital radio report was given with chief compliant and treatments listed in the appropriate category of the report. Vitals was continued to be taken every 5
A week after initial admission, the patient is on the medical surgical floor recovering from his transverse colostomy five days ago. At 1200 vital signs are as follows, temperature 99.1; pulse 96; respirations 18; blood pressure 141/69; pulse ox is 94% on 1L NC in AM. The patient appears acutely ill and lays in bed with his eyes closed even when family comes into the room to check on him. He is alert and oriented to person, but not place or situation. He appears lethargic and is slow to respond to questioning, this appears to be due to recent administration of pain medication. Pupils are equal round and reactive to light and grips are week bilaterally in hands. Abdomen is firm, distended, and non-tender. Colostomy site appears to be
This is a 61 years old man who was OSU in October for pneumonia. During his hospitalization, pt suffered from lung perforation during lung biopsy. Chest tube was in place until Dec 2nd. He was also treated for A-fib and started on Coumadin before he was sent to rehab. He was in rehab for 18 days. Before he discharged to home, he was told to hold talking Coumadin until next PT/INR- which is on Dec 21st. in addition, pt has a chronic ABD wound which is independent taking care of. The wound 1x1cm. The incision at chest tube removal site is approximated with steri strips and not s/s of compilation or infx.
Spending the day in the operating room (OR) can be an exhilarating experience, throughout this paper I will discuss the different aspects of surgery as you follow my journey. I will discuss pre- operative care and testing preformed; operative care, anesthesia, and possible complication; and post-operative care and recovery.
Based on the medical report dated 11/11/15, the patient returns for post-operative visit. He feels better and is doing well. He still has a bit of soreness and stiffness, which is expected at this time. He has not started any formal
He was admitted to the ICU because he had surgery to redone his stoma He was intubated because of respiratory failure after his abdominal surgery. his condition is very critical because the fluid from his wound vac and colostomy is dark red and patient is in distress. He was on constant monitoring for a change in his
The Veress needle puncture, optical trocar access, and the Hasson technique are the three common approaches to obtain pneumoperitoneum for laparoscopic exposure with very low complication rates. In 2001, Schafer et al. reviewed 14,243 laparoscopic procedures where pneumoperitoneum was obtained using the Veress needle, with overall complication rate of 0.18% (20). Similarly, Catarci et al. reviewed 12,919 laparoscopic procedures and reported low complication rates of 0.27% with optical trocar access, 0.18% with the Veress needle, and 0.09% with the Hasson technique (21).
Laparoscopic colectomy is surgery to remove part or all of the large intestine (colon). This procedure is used to treat several conditions, including:
This investigation was done to see which method offered more of an advantage for specialists who may have just recently finished a training programming in laparoscopy. These researchers observed that the transperitoneal approach, in contrast to its retroperitoneal counterpart, was better for the less-experienced. This is because it offers an operating field that is wider, as well as more anatomical familiarity. Moreover, suturing is more convenient following the
This malformation is the only one that requires not only a posterior sagittal approach but also an abdominal one, either by laparotomy or laparoscopy. But in a case of Rectobladder neck fistula, the rectum can be separated from the urinary tract laparoscopically avoiding a laparotomy. These patients do not have a good functional prognosis and they require a posterior sagittal approach to create the space through which the rectum will be pulled down. During the laparotomy or laparoscopy, the rectum must be separated from the urinary tract. In these very high malformations, the common wall between the rectum and the urinary tract is very short. In other words, the rectum connects to the bladder neck in a “T”
Laparotomy, which is an operation performed on organs within the abdominal cavity, is a common surgical procedure performed all over the world. Sutures or other materials such as fibrin sealants or staples provide mechanical support for the closed wound healing process. They approximate the wound edges and help to maintain wound closure until the healing process provides sufficient strength for the wound to withstand stress and strain without additional support. However, among the choices surgeons have for closing abdominal fascia, there is currently scant consensus as to the best material or method. For the majority of surgeons, the choice of a suture method in a given instance has mostly been directed by popular practice and opinion, with
The medical world is a place full of constant change and evolution. One area of medicine that has changed a lot over the last ten years is surgery. Instead of traditional open surgery, surgeons can now use a method called laparoscopic surgery. As defined, laparoscopic surgery is an “operative procedure performed using minimally invasive surgical technique for exposure that avoids traditional incision. Visualization is achieved using a fibre optic instrument, usually attached to a video camera” (Medical-Dictionary.com). Laparoscopic surgery is remarkable from how it works to the many different procedures that can be performed through laparoscopic surgery, and how much less trauma it causes the body than open surgery.
For years, surgical operations had a reputation for being extremely painful and uncomfortable, hindering the attending physician’s ability to operate on the patient receiving the surgery. However,
Laparoscopy has revolutionized surgery during the last three decades; however, the roots of minimally invasive surgery can be