HY Surgery - YouTube Dr. Price

Patient comes in and received blood products for some hemorrhage. 2 hours later, he develops fever and chills. This instance is indicative of acute febrile nonhemolytic transfusion reaction

• This can occur due to the recipient's immune response to donor white blood cells. It's important to monitor the patient closely and provide supportive care, including antipyretics.

  • It will resolve on its own with Tylenol

• To prevent this from occurring in the future, the cells transfused must be leukodepleted

Patient comes in and received blood products for some hemorrhage. 2 hours later, he develops hemoglobinuria and flank pain. This is indicative of hemolytic transfusion reaction from ABO incompatibility

• This is also an example of a never event, an event that should never occur

  • To prevent the never event, it is essential to implement strict protocols for blood typing and cross-matching prior to transfusions.

Patient comes in and received blood products for some hemorrhage. 6 hours later, he develops tachypnea. On lung examination, there are bilateral crackles. Jugular venous pressure is at 10 cm and there is 2+ edema. This is indicative of transfusion associated volume overload

• With these signs, the confirmatory test is chest X-ray

• To properly treat it, administer diuretics, nasal cannula oxygenation, and upright posture

A patient with necrotizing pancreatitis has been vomiting blood. Examination is notable for esophageal varices. This is because of splenic vein thrombosis

• The pancreas runs above the splenic vein

A patient has been vomiting blood. In addition to esophageal varices, the liver edge is palpated 7 cm below, their skin appears yellow, and the abdomen looks distended with RUQ pain. In this instance, it is hepatic vein thrombosis

A patient who suffered a traumatic cervical or thoracic spinal fracture is brought to the ER. There is a palpable step-off in the vertebrae. They go into shock, and when they do, they will develop bradycardia as well

• This is due to the loss of sympathetic tone.

A patient with history of prostate adenocarcinoma develops lower back pain and new onset motor/sensory deficits that suggest possible spinal cord compression. This warrants immediate MRI and intervention to assess for metastasis or epidural hematoma.

• If the deficits are bilateral lower extremity weakness, loss of DTR, bowel and bladder incontinence, and saddle anesthesia, these are all indicative of cauda equina syndrome

A patient who suffers a traumatic head injury has clear fluid draining from their ears. In this case, they have a basilar skull fracture with CSF drainage

• Will have high Cl content

• Basilar skull fracture will also have raccoon eyes, hematoma behind ear

A patient undergoes successful excision of BCC and the incision is healing well. However, pathology says the tumor on the excised sample is at the margins. This raises concerns about the potential for residual cancer, meaning the patient will need re-excision

• Do NOT wait and watch. In such cases, it is critical to discuss further surgical options promptly with the patient to ensure all cancerous tissue is removed effectively.

The very first step in any burn patient if it’s not already done is to administer Lactate Ringers

A diabetic patient can have any type of injury, from a simple cut to a broken bone. The instant they develop severe fever and crepitus in the wound, that is necrotizing fasciitis

• This is very aggressively and immediately treated with vancomycin, pip/tazo, clindamycin, fluids, and surgical debridement

• Do NOT go to imaging, do NOT go to any additional confirmatory test. Crepitus is all that is needed to confirm.

• Necrotizing fasciitis is one of those conditions where you need to act very quickly and very aggressively

A patient underwent a successful cholecystectomy. Some time later, they are in severe pain with HTN and tachycardia. In this case, increase their pain medications as inadequate pain control is causing increased sympathetic tone

A patient with a central line or PICC line develops fever. Blood cultures are positive, and the associated vein with the line is erythematous and indurated, and the catheter is draining pus. This scenario suggests catheter-related infection which may lead to septic thrombophlebitis; remove the catheter, give broad-spectrum abx, and excise the vein

• The sign here that indicates the worst prognosis is the drainage of pus

If there is a history of cancer, or the patient has acute dyspnea with tachycardia, and they are post-operative from a major surgery and they have other signs of pulmonary embolism, go straight to treatment of pulmonary embolism

A patient underwent liver transplant. 2 months later, they develop shortness of breath and fever. The chest is dull to percussion. This is indicative of empyema, which is a collection of pus in the pleural cavity. Immediate drainage of the empyema through thoracostomy/chest tube is essential, along with appropriate antibiotic therapy to manage the infection effectively.

A patient suffers a MVC. 24 hours later, they develop cough and crackles, but they are afebrile. This should get you thinking about lung/pulmonary contusion

• Hypoxia, tachypnea, decreased breath sounds can be present

• CT scan is the best confirmatory test

• Control pain, encourage deep breathing exercises, and monitor respiratory status closely to prevent further complications.

A patient suffers a MVC. The X-ray shows an obscured left hemidiaphragm and NG tube in the lower left side of chest. This is a diaphragmatic rupture

• The way you could remember this is it’s also called Bochdalek trauma, and Bochdalek sounds very similar to back left

For toxic megacolon, initially try bowel rest, NG tube

• Medical management is corticosteroids

• If that fails, go to surgery