Archie Comics 157 (August 1965) by Richard H. Goldwater, Frank Doyle, Joe Edwards, Sy Reit,

By Richard H. Goldwater, Frank Doyle, Joe Edwards, Sy Reit, Samm Schwartz

Archie Comics #157 - August 1965

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Extra resources for Archie Comics 157 (August 1965)

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42 23 ᭤ P R E O P E R AT I V E C AR E Preoperative identification of risk factors allows thoughtful planning of intraand post-operative management in an effort to optimize outcomes. In all patients, a comprehensive medical and surgical history should be obtained with specific attention paid to prior surgical complications and any underlying cardiac, pulmonary, endocrine, renal, or hematologic disorders. Preoperative evaluation should include ECG and CXR for men > 40 years and women > 55 years. Patients > 40 years should have basic laboratory evaluation (eg, electrolytes, complete blood count [CBC]).

Initial treatment includes withdrawal of inciting antibiotics and initiation of vancomycin (oral or enema) or metronidazole (IV or oral) therapy. Recurrent cases may treated by repopulating the colon with normal flora (probiotics). Surgical intervention is warranted for perforation, toxic dilation, or sepsis. ABSCESSES Infected tissue isolated by the body to defend against widespread bacterial infection. First-line therapy is drainage; postdrainage antibiotics may be given if infection is complicated or if patient is immunosuppressed.

Pulmonary auscultation reveals fine rales at the left lung base with diminished breath sounds. CXR shows an elevated left hemidiaphragm. What is the treatment? The patient’s fever is likely caused by atelectasis, which is in turn likely due to suboptimal pain control. Encourage deep breathing, ambulation, and consider placement of epidural for pain control. PULMONARY COMPLICATIONS Incidence is 7% following major noncardiac surgery. Atelectasis, a segmental collapse of the airway, is often caused by poor inspiratory effort in the setting of poorly controlled postoperative pain.

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