Goals/Objectives Anatomy and Physiology Review Indications Technical considerations Pleural Effusion Bret A. Nicks David E. Manthey From Adams JG, et al: Emergency Medicine Clinical Essentials, 2nd edition (Saunders 2012) Ultrasonography Ultrasonography is effective for visualizing an effusion and determining whether the fluid is free flowing or loculated ( Figure 68-1-1 ). In a prospective study, Piccoli et al. compared ultrasonography, physical examination, and radiography in patients with suspected effusions. Findings…

Goals/Objectives Indications Anatomic considerations Technical considerations Hemodynamic Monitoring Andrew Rhodes R. Michael Grounds E. David Bennett From Vincent JL, Abraham E, Moore FA, Kochanek PM, Fink MP: Textbook of Critical Care, 6th edition (Saunders 2011) Arterial Pressure Monitoring Noninvasive measurement of blood pressure is one of the most widely undertaken procedures in clinical medicine. Invasive techniques are more commonly employed in intensive care patients for several reasons. Most importantly,…

Goals/Objectives Indications Anatomic Considerations Technical Considerations Paracentesis and Diagnostic Peritoneal Lavage Louis H. Alarcon From Vincent JL, Abraham E, Moore FA, Kochanek PM, Fink MP: Textbook of Critical Care, 6th edition (Saunders 2011) Paracentesis: Before Procedure Indications Paracentesis is the insertion of a needle or catheter into the peritoneal cavity for the purpose of aspirating peritoneal fluid. It is most often indicated for diagnostic or therapeutic evacuation…

Goals/Objectives Indications Types of therapy Devices Surgical Critical Care Charles A. Adams Andrew Stephen William G. Cioffi From Townsend CM: Sabiston Textbook of Surgery, 19th edition (Saunders 2012) Ventilatory Support Noninvasive Ventilatory Support Many patients require more support than a passive O 2 delivery device. Several noninvasive ventilatory interventions can support oxygenation and ventilation, and possibly obviate the need for endotracheal intubation and mechanical ventilation. Intermittent positive pressure breathing…

Goals/Objectives Rationale for Enteral vs Parenteral Indications Modes of delivery Complications Metabolism in Surgical Patients Ahmed Al-Mousawi Noe A. Rodriguez David N. Herndon From Townsend CM: Sabiston Textbook of Surgery, 19th edition (Saunders 2012) Nutritional Support Surgical patients with suboptimal nutritional support have impaired wound healing, altered immune responses, accelerated catabolism, increased organ dysfunction, delayed recovery, and increased morbidity and mortality. Following surgery, patients who are inadequately fed become…

Goals/Objectives Basic Principles Anatomy Physiologic Considerations Technical Considerations Management of Complications Tracheal Intubation Scott Savage From Pfenninger JL, Fowler GC: Pfenninger & Fowler's Procedures for Primary Care, 3rd edition (Saunders 2010) Airway emergencies can be some of the most daunting situations a practitioner encounters. Radical advances in airway management have been made and are reviewed here. Indications Hypoxia Respiratory distress Protection of the airway Cardiopulmonary arrest Need…

Goals/Objectives Indications Technical considerations Cardiopulmonary and Cerebral Resuscitation Clifton W. Callaway From Vincent JL, Abraham E, Moore FA, Kochanek PM, Fink MP: Textbook of Critical Care, 6th edition (Saunders 2011) Rational Use of Rescue Shocks for Defibrillation Delivery of immediate transthoracic electric (rescue) shocks to patients in VF can convert VF into an organized cardiac rhythm. Rescue shocks are highly effective when VF is of very brief…

Goals/Objectives Etiology Anatomic considerations Management considerations Abdominal Compartment Syndrome and Management of the Open Abdomen Joseph F. Sucher Zsolt J. Balogh Frederick A. Moore From Cameron JL, Cameron AM: Current Surgical Therapy, 10th edition (Mosby 2011) Diagnosis Identifying at-risk patients and preventing ACS is paramount to achieving optimal patient outcomes. However, ACS occurs across a heterogeneous group of patients; thus identifying at-risk patients will depend on the local patient…

Goals/Objectives Anatomic landmarks Technique of insertion Ultrasound guided Complications Hemodynamic Monitoring Andrew Rhodes R. Michael Grounds E. David Bennett From Vincent JL, Abraham E, Moore FA, Kochanek PM, Fink MP: Textbook of Critical Care, 6th edition (Saunders 2011) Central Venous Pressure Central venous pressure (CVP) is the intravascular pressure in the great thoracic veins, measured relative to atmospheric pressure. It is conventionally measured at the junction of the superior…

Goals/Objectives Indications Techniques Complications Monitoring of the Heart and Vascular System David L. Reich Alexander J.C. Mittnacht Gerard R. Manecke Joel A. Kaplan From Kaplan JA, Reich DL, Savino JS: Kaplan's Cardiac Anesthesia: The Echo Era, 6th edition (Saunders 2011) Key Points 1. Patients with severe cardiovascular disease and those undergoing surgery associated with rapid hemodynamic changes should be adequately monitored at all times. 2. Adequate monitoring is based on…

Goals/Objectives Types of Intubation Surgical Airway Ventilator Settings/Management Airway Management in the Trauma Patient Kent A. Stevens Elliott R. Haut From Cameron JL, Cameron AM: Current Surgical Therapy, 10th edition (Mosby 2011) Airway Intervention: Decision-Making and Physiologic Considerations The decision to intervene to provide a definitive airway should be driven by the patient's presentation and ability to protect the airway. Box 58-1-1 lists some indications for definitive airway…

Goals/Objectives Basic Principles Anatomy Physiologic Considerations Technical Considerations Management of Complications Necrotizing Skin and Soft Tissue Infection Eileen M. Bulger From Cameron JL, Cameron AM: Current Surgical Therapy, 10th edition (Mosby 2011) Overview Necrotizing skin infections and necrotizing soft tissue infections (NSTIs) are the most severe form of bacterial infection in the soft tissues, and they represent a wide spectrum of disease. Common synonyms that have been…

Goals/Objectives Anatomy and Physiology Review Indications Technical considerations Biopsy Techniques Joseph F. Sobanko Justin J. Leitenberger Neil A. Swanson Ken K. Lee From Rigel DS, et al: Cancer of the Skin, 2nd edition (Saunders 2011) You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Goals/Objectives Indications Anatomic considerations Technical considerations Regional Lymph Node Surgery in Melanoma Patients Merrick I. Ross From Rigel DS, et al: Cancer of the Skin, 2nd edition (Saunders 2011) Sentinel Lymph Node Biopsy (SLN) History and Rationale Surgical strategies for stage I and II patients have included two main components: wide excision of the primary tumor or biopsy site and regional lymph node evaluation. While recommendations for the…

Goals/Objectives Diagnosis Principles of management Currettage Flaps Pilonidal Disease Heidi Nelson From Townsend CM: Sabiston Textbook of Surgery, 19th edition (Saunders 2012) Pilonidal Disease Pilonidal infections and chronic pilonidal sinuses typically occur in the midline of the sacrococcygeal skin of young men. Although the exact pathogenesis of pilonidal disease remains elusive and controversial, hair seems to play a central role in the process of infection and perpetuation…

Goals/Objectives Pathogenesis Indications Techniques Melanoma and Cutaneous Malignancies Kelly M. McMasters Marshall M. Urist From Townsend CM: Sabiston Textbook of Surgery, 19th edition (Saunders 2012) The ABCDEs of melanoma are used to guide the decision about performing a biopsy – a symmetrical irregular b orders, variable shades of c olor, d iameter greater than 6 mm, and e volution, or change over time. However, many melanomas do not follow…

Goals/Objectives Anatomy Workup of Thyroid Nodule Technique Thyroid Philip W. Smith Leslie J. Salomone John B. Hanks From Townsend CM: Sabiston Textbook of Surgery, 19th edition (Saunders 2012) Historical Perspective The name thyroid is derived from the Greek description of a shield-shaped gland in the anterior aspect of the neck ( thyroides ). Classic anatomic descriptions of the thyroid were available in the 16th and 17th centuries, but the…

Goals/Objectives Basic Principles Anatomy Physiologic Considerations Technical Considerations The Parathyroid Glands Julie Ann Sosa Robert Udelsman From Townsend CM: Sabiston Textbook of Surgery, 19th edition (Saunders 2012) Hypoparathyroidism Hypoparathyroidism is an endocrine disorder in which hypocalcemia and hyperphosphatemia are the result of a deficiency in parathyroid hormone (PTH) secretion or action. The most common cause of hypoparathyroidism is damage to the parathyroid glands during thyroidectomy, but it can…

Goals/Objectives Anatomy and Physiology Review Indications Technical considerations You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Goals/Objectives Indications Anatomic considerations Technical considerations Diseases of the Breast Kelly K. Hunt Marjorie C. Green Thomas A. Buchholz From Townsend CM: Sabiston Textbook of Surgery, 19th edition (Saunders 2012) Selection of Surgical Therapy Mastectomy and breast conservation therapy have been shown to be equivalent in terms of patient survival; therefore, the choice of surgical treatment for patients with stage I or II disease is individualized. Patients who desire…