Definite diagnosis: Ultrasound and abdominal puncture

Shock occurs within 24 hours

Tachycardia, decreased blood pressure, decreased urine output, peripheral vasoconstriction

If bleeding continues, abdominal circumference may increase

The amount of blood flowing out of the chest drainage tube continues to exceed 100ml per hour

Chest X-ray

Urine output less than 25ml per hour

main reason

deal with

risk factors

Insufficient hemostasis, residual dead space, and tissue trauma during surgery

Hypoinflation, pneumonia, urinary tract infection, purulent or non-purulent phlebitis

Anesthetics block the body's regulatory processes

Heat loss during laparotomy and thoracotomy surgery

Infuse cold fluids or bank blood

Significant increase in peripheral vascular resistance

weakened heart contractility

Decreased cardiac output

Nervous system is depressed

Coagulopathy

More traumatic surgeries

Give large amounts of cold fluids or bank blood

Tap on the chest and back to encourage coughing and deep breathing, and to aspirate secretions through the nose and trachea. For patients with severe chronic obstructive pulmonary disease, aerosolized bronchodilators and mucolytic drugs are effective. When there is airway obstruction, bronchoscopy should be performed.

Underexpansion of the lungs

Aspiration of foreign bodies and large secretions

People with abdominal infection who require long-term assisted breathing

Age (over 50 years old)

deep vein thrombosis of lower limbs

Trauma, soft tissue injury, burns

Cardiopulmonary disease, obesity

Certain blood diseases and metabolic diseases (diabetes)

Sudden dyspnea

Chest pain, hemoptysis, syncope

Unexplained acute right heart failure or shock, decreased blood oxygen saturation

Pulmonary valve area systolic murmur, P2 hyperactivity

General treatment: intensive care, absolute bed rest, appropriate use of sedation and analgesic drugs to relieve the patient's anxiety and panic

Respiratory support: oxygen inhalation, endotracheal intubation and mechanical ventilation

Loop support

Thrombolytic and anticoagulant therapy

Fever, abdominal pain, abdominal tenderness, and increased white blood cells

After the abdominal abscess is located, puncture and catheter drainage can be performed under ultrasound guidance. If necessary, open drainage is required.

Antibiotic treatment is selected based on the drug susceptibility results of bacterial culture.

Amphotericin B

fluconazole

Disadvantages of hemostatic techniques

Contributing factors

Discomfort, swelling, raised edges, and discoloration at the incision site

Blood sometimes leaks through stitches in the skin

Evacuate the blood clot under sterile conditions, ligate bleeding vessels, and re-sew the wound

Malnutrition, poor tissue healing ability

Incision suturing technique is defective

A sudden increase in intra-abdominal pressure, such as severe coughing or severe abdominal distension

Partial dehiscence: except for skin sutures that are intact and not dehisced, all deep tissue dehiscences

Complete dehiscence: the incision is fully dehisced, with bowel or omentum prolapsed

① On the basis of suturing the abdominal wall incision layer by layer, add full-thickness abdominal wall tension-reducing sutures; ② The incision should be sutured under good anesthesia and abdominal wall relaxation to avoid forced sutures that may cause tearing of the peritoneum and other tissues; ③ Treat abdominal distension in a timely manner; ④ When the patient coughs, it is best to lie down on his back to reduce the sudden sharp drop of the diaphragm and the sudden increase in intra-abdominal pressure during coughing; ⑤ Appropriate abdominal pressure bandaging also has a certain preventive effect.

If the incision is not completely dehiscent: immediately cover the incision with a sterile dressing, suture it under good anesthesia conditions, and add tension-reducing sutures.

Complete dehiscence of the incision: intestinal paralysis often occurs after re-suturing, and gastrointestinal decompression should be placed after surgery. The treatment of partial splitting of the incision depends on the specific situation.

Pre-existing contamination of the urinary tract, urinary retention and various urinary tract procedures

About 5% of patients with bladder intubation for a short period of time (<48 hours) develop bacteriuria, but only 1% have clinical symptoms.

Strictly require aseptic operation to prevent urinary system contamination, prevent and quickly treat urinary retention

Give adequate fluids, complete bladder drainage, and targeted antibiotics