Week in Review: Jan 22 - 27th
Often plan films will not see food, CT scan is high yeild test to find esophageal FB
Recommend against use of proteolytic enzymes to dissolve meat
Glucagon 1-2mg IV to relax lower sphincter, although rarely works
Gass forming agents (carbonated beverages) have success rate up to 80%
Endoscopy via GI is definitive management. If greater than 12 hrs, call them up front.
Internal Hernia - hernia stuck through new defect in mesentery - strangulation and necrosis
Bleeding - usually early post op along suture / stable line
Abastomotic leak - usually early but can be dealyed by days to weeks. Look for persistent tachycardia, CT not sensitive enough
PE - #2 cause of death in post bariatric patients
Even more listed in entire post
Watch for heat injuries especially with large number of plaster layers
Pressure Sore - look for pressure points and add extra padding
Compartment syndrome - document a post splint neurovascular exam
Step one = EKG, if new ST changes, ischemia or arrhythmias admit to tele for monitoring
Normal EKG and negative troponin make blunt cardiac injury extremely unlikley
Sternal fracture does not equal blunt cardiac injury
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