Resident Readiness General Surgery (84 page)

Sodium–potassium exchange resin,
258

Soft tissue infection,
103

Somatic pain,
47
.
See also
Pain

Somatic sensory afferent nerve signals,
47

Sphincterotomy,
283

Spinal injury,
44

Spontaneous pneumothorax,
188

Standard fasciotomy,
131

Standard pain medications

relative strengths,
145
t

Standard therapy,
7

Staphylococcus aureus
,
270
,
338

Stimulant laxatives, for constipation,
230

Stress,
16

Stressor,
70

Suboptimal oxygen consumption,
69

Sulfonylureas,
279

Superficial abscess

adequate drainage of,
103

    incision,
103

    packing,
103

bulge, painful,
101
–104

incision and drainage (I&D) of,
102

location,
102

microbiology of,
101

patient anxiety/pain tolerance,
102
–103

size and depth,
102

surrounding structures,
102

Superficial femoral artery,
114

Supine film,
215

Supraventricular dysrhythmias, cardiac arrhythmia,
169
–171

Supraventricular tachycardias (SVT),
195

Surgical admission,
33
.
See also
Admission

Surgical disease,
33

Surgical dogma,
135

Surgical fever, definition of,
261
.
See also
Postoperative fever

Surgical intern, morality,
305
–306

Surgical residency,
13
,
15

family planning,
15

personal life management,
14
–15

resident of, responsibilities of,
13
,
14

successful parent, tips for,
16
–18

tips to,
18

work–life balance,
13
–14

Surgical therapy,
7

Surveyor

primary,
42

secondary,
42

Surviving sepsis campaign,
58

Swan catheter,
70

Symptom-triggered protocols,
126

Systematic error,
108

Systemic antibiotic therapy,
135

Systemic inflammatory response syndrome (SIRS),
77
,
194
,
261

diagnosis of,
78

relationship sepsis,
79
f

Systemic perfusion,
196

Systemic vascular resistance (SVR),
195
,
210

Systolic blood pressure (SBP),
201

T

T-ACE screening tools,
124
t

Tachyarrhythmias,
195

Tachyarrythmia,
170

Tachycardia,
169

Tachypnea,
264

Team leader,
39
,
41

Teamwork,
10

attitude for,
10

Tension pneumothorax,
167

Terminal ileum (TI),
59

Thienopyridines,
283

Thrombocytopenia,
348

Thromboembolectomy,
118

Thyroid function tests,
228

Tibioperoneal (TP) trunk,
114

Time management

for admissions,
34
–35

concise notes,
9

efficiency and,
9

wasting time,
9

Tissue plasminogen activator (tPA),
118

Toradol,
144

Total body surface area (TBSA),
129

TPN, infusions,
110

Tracheal deviation,
43

Transfusion reactions,
95
–97

acute,
96

delayed,
97

hemolytic,
97

Transfusion-related acute lung injury (TRALI),
97

Transfusion Requirements in Critical Care (TRICC) trial,
91
–93

Trauma,
131

activation

    anatomic, physiologic, mechanistic, and high-risk criteria for,
40
t

primary survey

    goal of,
42
,
44

    motor vehicle accidents,
39
–44

team,
39
,
41
f

Traumatic brain injury,
124

Trenches

nurses knowledge,
8

simple rules from,
8
–9

Triage, in admissions,
33
–34

Tunneled central venous catheter placement,
159
f

Tylenol,
263

U

Ultrasound,
102

Urinalysis,
111

interpretation of,
110

Urinary retention,
206

Urology consultation,
243

UTIs,
262

V

Valvular heart disease,
195

Vascular smooth muscle relaxant,
209

Vascular surgery,
206

Vasoconstriction,
206

Vasopressin,
73

Ventricular demand pacer,
181

Ventricular dysfunction,
206

Ventricular fibrillation (VF),
185

Ventricular hypertrophy,
196

Ventricular tachycardia,
174
,
175
f

Ventricular tachydysrhythmias

premature ventricular contractions (PVCs),
173
–175

Vertebral bodies,
155

Vicodin,
144

Visceral ischemia,
34

Visceral pain,
47
,
48
.
See also
Pain

perceived locations of,
48
f

vague,
49

Visceral sensory neurons,
48

Vital signs,
165

Vitamin K–dependent carboxylation,
283

Vomiting,
213
–218

vWD, suspicion,
351

W

Warfarin,
118
,
282
,
283

anticoagulation,
283

hernia repair,
281
–283

K–dependent clotting factors,
286

pharmacokinetics,
283

Warfarin, anticoagulants,
317

Water-soluble contrast enema,
229

Wernicke encephalopathy,
126

Whipple procedure,
193

Wide morphology complex,
175

Work-hour restrictions,
17

Work–life conflicts,
13

Wound complications, postoperative,
331
–338

abdominal wall depicting, cross-section of,
335
f

antibiotic, skin incision,
333

classification,
332

clean contamination,
332
t

contamination,
331

diagnosis of,
334

gunshot,
339

hematomas,
333
,
334

imaging,
334

infection,
332
,
332
t
,
333
,
334

management of,
336

organ/space SSI,
340

pathogen,
337
,
338
t

seromas,
334

seromas/hematomas/gi tract, gross spillage,
339
,
340

surgical site infection risk,
332
t
,
335
f

Wound healing,
274

Wound infections,
332
–334,
336
–338,
338
t

Wound, type,
338
t

X

Xyphoid process,
86

Table of Contents

Copyright Page

Dedication

CONTENTS

Contributors

Acknowledgments

I. Introduction

1. Welcome

2. How to Read this Book

3. General Advice

4. A 28-year-old Female Incoming Surgery Resident

5. How to Write a Note—Fast!

II. Handling Patients in the ED

6. Admissions

7. A 56-year-old Female Status Post Motor Vehicle Accident

8. A 40-year-old Female With Abdominal Pain

9. A 42-year-old Man With Severe Right Upper Quadrant Pain

10. A 23-year-old Student With Periumbilical Pain That Has Migrated to Her RLQ

11. A 65-year-old Female in Severe Abdominal Pain

12. A Patient in the ER With a Blood Pressure of 60/– and a Heart Rate of 140

13. A 67-year-old Man With Mental Status Changes and a Suspected Diverticular Abscess

14. A 57-year-old Man With a Chief Complaint of Nausea and Vomiting

15. A 65-year-old Man Status Post Surgery With a HCT of 24%

16. A 70-year-old Man With “Bad Blood”

17. A 37-year-old Man With a Painful Bulge Over His Left Forearm

18. Three Patients All Present With Issues Related to Laboratory Tests

19. A 73-year-old Man With Acute Right Lower Extremity Pain

20. A 36-year-old Woman Status Post Motor Vehicle Accident While Intoxicated

21. A 50-year-old Man Presenting With Extensive Burns

22. A 56-year-old Man 6 Days Status Post Colectomy With New Pelvic Discomfort

III. Handling Inpatients

23. A 75-year-old Man With Postoperative Pain

24. A 72-year-old Man With Acute Confusion Postoperatively

25. You (the Intern) Are Asked to Read a Chest X-ray

26. A 65-year-old Woman in Respiratory Distress

27. A Patient Who Is Postoperative Day 2 With New-onset Chest Pain

28. A 65-year-old Woman With a New-onset Cardiac Arrhythmia

29. A 60-year-old Man in the PACU With New-onset PVCs