Bandeiras vermellas post-alta cirúrxica, hemorraxia interna e infección¶

Máis do 65 por cento dos procedementos cirúrxicos en todo o mundo realízanse agora de forma ambulatoria (paciente ambulatorio) ou de alta rápida, o que significa que millóns de pacientes recupéranse da anestesia xeral, bloqueos da columna vertebral, laparoscopia, acceso vascular e operacións ortopédicas ou abdominais dentro das súas propias casas ás poucas horas de saír do quirófano. Aínda que a maioría da dor postoperatoria, as náuseas leves e os hematomas de baixo grao resolvense sen problemas, os primeiros 14 días despois da cirurxía teñen grandes consecuencias para hemorraxia interna oculta, hematomas en expansión das vías respiratorias, hipertermia maligna retardada, ferida abdominal, dehiscencia abdominal**, dehiscencia abdominal, dehiscencia intestinal embolia pulmonar e sepsis postoperatoria.

As súas prioridades inmediatas á hora de atender a un paciente cirúrxico recentemente dado de alta que se deteriora na casa son distinguir a recuperación cirúrxica esperada das emerxencias cirúrxicas que ameazan a vida, convocar os servizos médicos de emerxencia antes de que o choque sexa irreversible, manter o estómago do paciente completamente baleiro (nada por vía oral) no caso de que sexa necesario un retorno urxente ao quirófano, protexer os tecidos expostos ou transmitir o procedemento aéreo. e documentación de alta aos paramédicos.

Fai isto agora¶

1. Chame inmediatamente aos servizos médicos de emerxencia por calquera sinal postoperatorio que poña en perigo a vida: Chame ao teu número de emerxencia local (911 nos Estados Unidos e Canadá, 112 en toda a Unión Europea, 999 no Reino Unido, 000 en Australia) ou consulta o noso directorio de números de emerxencia se o paciente presenta falta de aire, dor no peito, desmaio, mareos ao estar sentado, sangue vermello brillante que atravesa os apósitos, inchazo rápido do pescozo despois dunha cirurxía de tiroides ou carotídeos, músculos ríxidos con febre en aumento ou incisión abdominal que se abre.
2. Aplicar a NPO estrita (nada por vía oral) inmediatamente: Non lle dea ao paciente auga, chips de xeo, alimentos ou medicamentos para a dor oral unha vez que se sospeite dunha complicación cirúrxica. Se o paciente debe ser trasladado de novo á cirurxía para deter o sangrado interno ou reparar unha fuga intestinal, ter auga ou alimentos no estómago corre o risco de aspiración mortal durante a indución da anestesia xeral de emerxencia.
3. Deitar o paciente en caso de sospeita de sangrado interno ou shock: Se o paciente está pálido, frío, húmedo, mareado ou taquicárdico (frecuencia cardíaca superior a 100 latidos por minuto en repouso), déixao de costas e levante as pernas de 15 a 30 centímetros (de 6 a 12 polgadas) a menos que a dor abdominal ou pediátrica cause elevación cirúrxica ou abdominal.
4. Aplicar presión directa e firme sobre a hemorraxia cirúrxica externa (excepto na tráquea): Se o sangue vermello brillante está empapado a través dun apósito cirúrxico nun membro, peito, ingle ou abdome, non retire a capa inferior de gasa; Apile toallas ou gasas limpas e secas dobradas directamente enriba e prema firmemente coas dúas mans.
5. Cubra as incisións abdominais abertas (dehiscencia) cun apósito húmido estéril: Se os puntos cirúrxicos ou as grapas ceden e aparecen líquido rosado ou asas de intestino na ferida, nunca empurra os órganos para dentro. Cubra a ferida aberta sen soltura cunha toalla limpa ou gasa estéril empapada en solución salina estéril ou auga morna limpa da billa, e dobra lixeiramente os xeonllos do paciente sobre unha almofada para eliminar a tensión da parede abdominal.
6. **Recolle o paquete de descarga cirúrxica e o rexistro de anestesia: ** Entregue aos paramédicos o resumo da alta hospitalaria, o número de teléfono de garda de emerxencia das 24 horas do cirurxián, a tarxeta de implante operativo (se se colocou hardware ou malla) e todos os anticoagulantes e analxésicos prescritos.

flowchart TD
    Start["O paciente post-cirúrxico se deteriora na casa (entre horas e 14 días despois do alta)"] --> Triage{"1. Identificar o patrón de emerxencia primaria"}
    Triage -->|Shortness of Breath, Chest Pain, or Neck Swelling| AirwayPE["Crise das vías respiratorias/vasculares: chame ao 911/112/999, sinte de pé, comprobe se hai hematoma de pescozo en expansión ou embolia pulmonar"]
    Triage -->|Pale, Sweaty, Dizzy, Heart Rate Over 100, or Expanding Belly/Thigh| Bleed["Hemorragia interna ou externa: chame ao 911/112/999, deite, presione firmemente sobre o sangrado externo, mantén NPO"]
    Triage -->|Jaw/Muscle Stiffness, Rapid Fever Over 38.8 C, Dark Urine Within 24 Hours| MH["Sospeitoso de hipertermia maligna retardada: chame ao 911/112/999, quite a roupa, a néboa e a pel do abanico, as bolsas de xeo na ingle/pescozo"]
    Triage -->|Pink Salmon Fluid Gush from Belly Incision or Bowel Visible| Dehisce["Dehiscencia / evisceración da ferida: chame ao 911/112/999, cubra cunha toalla limpa húmida e quente, doble os xeonllos sobre a almofada"]
    Triage -->|Fever, Confusion, Shivering Chills, or Worsening Belly Pain Day 3 to 10| Sepsis["Sospeita de fuga anastomótica ou sepsis: chame ao 911/112/999 ou ao cirurxián inmediatamente, non garde nada pola boca"]
    AirwayPE --> NPO["2. Facer cumprir NPO estrito (sen auga, alimentos ou pílulas orais) en caso de reoperación inmediata"]
    Bleed --> NPO
    MH --> NPO
    Dehisce --> NPO
    Sepsis --> NPO
    NPO --> Docs["3. Reúna o resumo da descarga cirúrxica, o rexistro de anestesia e todos os frascos de medicamentos para o EMS"]

Cronoloxía das complicacións postoperatorias: cando se producen crises específicas¶

As complicacións cirúrxicas seguen liñas de tempo biolóxicas previsibles baseadas na hemostase, o metabolismo anestésico, a resistencia á tracción da ferida e a replicación bacteriana. Comprender en que día está o paciente ("o día postoperatorio 0" é o día da cirurxía) axuda aos coidadores a recoñecer o que está fallando dentro do corpo.

Concealed internal bleeding and post-operative hemorrhagic shock¶

Unlike external bleeding from a skin laceration, post-operative internal bleeding happens silently inside closed body cavities, the peritoneal cavity (abdomen), the retroperitoneum (behind the kidneys and pelvis), the pleural space (chest), the pericardium (around the heart), or deep fascial compartments of the thigh and hip. A patient can lose 1.5 to 2.5 liters (3 to 5 pints) of blood into their abdomen after a laparoscopic gallbladder removal, hysterectomy, hernia repair, or colonoscopy polypectomy, or into their thigh after a hip replacement, without a single drop of blood appearing on the outside skin bandage.

Why abdominal bloating is a late sign and orthostatic vitals are an early sign¶

The adult peritoneal cavity can expand to hold several liters of blood with minimal visible waist circumference increase. In addition, healthy young and middle-aged adults constrict their peripheral blood vessels to keep their lying-down blood pressure normal until they have lost 30 percent of their total blood volume. Look instead for these early compensatory red flags:

• Unexplained resting tachycardia (Heart rate over 100 to 110 beats per minute): After accounting for pain, a persistently climbing resting pulse rate is often the very first objective sign of internal bleeding or an anastomotic leak.
• Orthostatic dizziness or syncope (fainting on standing or sitting up): The patient feels fine lying flat in bed, but the moment they sit on the edge of the mattress or walk to the bathroom, their vision tunnels or goes black, their ears ring, they break out in a cold sweat, and they collapse.
• Referred diaphragmatic shoulder-tip pain (Kehr sign): While mild shoulder ache during the first 24 hours after laparoscopic surgery is common from harmless residual carbon dioxide inflation gas, new, severe, or worsening pain in the tip of the left or right shoulder accompanied by weakness, pallor, or lightheadedness indicates liquid blood pooling under the diaphragm and irritating the phrenic nerve.
• Surgical drain output alarms: If the patient was sent home with a closed-suction surgical bulb drain (such as a Jackson-Pratt or Blake drain) and the bulb suddenly fills rapidly with bright red, warm blood exceeding 100 milliliters per hour (or more than 200 milliliters in 2 hours), an arterial or major venous vessel is actively bleeding.
• Femoral catheterization / groin puncture site hematoma: After cardiac catheterization, coronary stenting, or endovascular surgery via the groin (femoral artery) or wrist (radial artery), a rapidly expanding, rock-hard, throbbing lump under the groin skin, or sudden severe lower back and flank pain with low blood pressure (retroperitoneal hemorrhage), is a life-threatening arterial emergency.

Immediate first aid for post-operative hemorrhage¶

1. Position flat and elevate legs: Lay the patient flat on their back on the bed or floor and prop their feet up 15 to 30 centimeters (6 to 12 inches) to return venous blood to the heart. Never walk a dizzy post-op patient to a car; call an ambulance so paramedics can start large-bore intravenous lines on the bedroom floor.
2. Direct pressure over groin or peripheral arterial puncture sites: If bright red blood spurts or swells from a femoral artery catheter site in the groin, put on gloves, place a thick folded roll of gauze or a clean washcloth directly 1 to 2 centimeters (0.5 to 0.8 inches) above (superior to) the skin puncture mark (where the artery actually enters the vessel wall deeper inside), and press straight down toward the hip bone with your full body weight using both hands locked together until paramedics take over.
3. Never unclamp or strip a surgical drain tube unless instructed by the surgeon, and never pull out a surgical drain.
4. Keep the patient warm with dry blankets: Hypothermia paralyzes blood clotting enzymes (the lethal triad of trauma and surgical bleeding). Cover the patient with warm blankets while waiting for the ambulance.

Expanding neck hematoma and post-thyroid / carotid airway crisis¶

Operations on the neck, including thyroidectomy, parathyroidectomy, carotid endarterectomy, anterior cervical spine discectomy and fusion (ACDF), and neck dissection, carry a unique, hyperacute danger during the first 6 to 24 hours after surgery: an expanding cervical hematoma.

Because the deep fascial layers of the neck form a tight, non-stretchable collar around the trachea (windpipe), even a small collection of 50 to 100 milliliters of blood inside the surgical bed increases compartment pressure rapidly. Before the hematoma is large enough to crush the rigid cartilage rings of the trachea directly, the pressure blocks venous and lymphatic drainage from the larynx (voice box), causing massive, rapid laryngeal mucosal edema that seals the airway shut within minutes.

Red flags of an expanding neck hematoma (Call emergency services immediately)¶

• Sense of impending doom and restlessness: The patient suddenly sits bolt upright, clutches at their collar or surgical neck bandage, and states "I cannot breathe" or "My neck feels like I am being choked."
• Progressive swelling, tightness, or fullness under the neck incision: The front or side of the neck balloons outward, feels firm or tense like wood, and obliterates the normal hollow above the breastbone (suprasternal notch).
• Voice changes and dysphagia: The patient's voice becomes muffled, hoarse, or high-pitched, and they cannot swallow their own saliva (drooling).
• Inspiratory stridor (a late, pre-arrest sign): A high-pitched, squeaking, or crowing sound heard when the patient breathes in. Once stridor appears, the airway diameter is already reduced by more than 70 to 80 percent, and complete asphyxiation can occur within minutes.

Immediate first aid for post-operative neck swelling¶

1. Keep the patient sitting bolt upright (high Fowler position): Never lay a patient with neck swelling or stridor flat on their back; gravity and supine venous engorgement will immediately close the remaining airway. Let them sit upright leaning slightly forward.
2. Loosen or cut away tight outer neck wraps immediately: If a circumferential gauze wrap, tape, or cervical collar is pressing tightly against the swelling neck, carefully cut or peel away the outer constricting tape to relieve external pressure (unless it is a rigid spine collar after unstable neck fracture surgery, in which case open the front tracheostomy access window if instructed by emergency dispatch).
3. Stay on speakerphone with emergency dispatch and the operating surgeon: In extreme cases where a patient loses consciousness and turns blue from complete airway obstruction due to a post-thyroidectomy hematoma before paramedics arrive, emergency medical control may guide a trained responder through emergency bedside suture release (the UK Difficult Airway Society SCOOP protocol: Skin exposure, Cut sutures, Open skin, Open muscles, Pack wound), which relieves venous congestion enough to restore breathing. For lay caregivers, immediate ambulance dispatch with lights and sirens ("expanding post-thyroidectomy hematoma with stridor") alerts paramedics to prepare emergency surgical airway equipment.

Post-tonsillectomy secondary hemorrhage (Days 5 to 14)¶

Children and adults who undergo tonsillectomy form thick white-gray fibrinous scabs (eschar) over the tonsillar beds inside the back of the throat. Between Post-Operative Day 5 and Day 10, as new mucosal skin grows underneath, these scabs slough off. In 2 to 5 percent of patients, a scab peels away prematurely and opens an underlying branch of the external carotid artery.

• First aid during an active tonsillectomy bleed:
• Call your local emergency number immediately.
• Keep the child or adult sitting upright and leaning forward over a bowl or sink so they can spit all blood out of their mouth. Encourage them not to swallow the blood, as swallowed blood hides the true volume of blood loss and triggers violent vomiting that dislodges clots.
• If the patient is fully alert and cooperative, having them gently swish and spit ice-cold water or suck on a crushed ice chip (only if awake and not choking) while holding a cloth-wrapped ice pack against the outside back and sides of the neck helps constrict throat blood vessels until paramedics arrive.
• If the patient becomes drowsy or faints, roll them immediately onto their side in the recovery position with the head angled slightly downward so blood drains out of the cheek onto the floor rather than into the windpipe.

Delayed malignant hyperthermia and local anesthetic systemic toxicity (LAST)¶

While most anesthesia-related emergencies occur inside the hospital recovery room, rapid outpatient discharge means caregivers must recognize two critical post-anesthesia reactions that can present at home during the first 12 to 24 hours.

1. Delayed post-anesthesia malignant hyperthermia (MH)¶

Malignant hyperthermia (MH) is an inherited pharmacogenetic disorder of skeletal muscle calcium channels (most often the RYR1 gene). When an MH-susceptible person is exposed to volatile inhaled general anesthetics (sevoflurane, desflurane, isoflurane) or the depolarizing muscle relaxant succinylcholine, calcium floods uncontrollably from the sarcoplasmic reticulum into the muscle fibers. The muscles lock into continuous contraction, consuming oxygen, producing vast amounts of carbon dioxide and lactic acid, and driving core body temperature upward at a rate of 1 degree Celsius (1.8 degrees Fahrenheit) every 5 minutes.

Although 90 percent of MH crises begin during surgery or within 1 hour of anesthesia cessation, post-operative MH can flare up hours after a patient returns home from outpatient surgery, or a patient who had a mild, unrecognized reaction in surgery may develop fulminant rhabdomyolysis that evening.

• Red flags of post-anesthesia malignant hyperthermia:
• Unexplained jaw stiffness (masseter spasm) or generalized rock-hard stiffness and severe cramping in the calves, thighs, abdomen, and back after general anesthesia.
• Rapid, deep breathing (tachypnea) and racing heart rate as the body tries to blow off excess carbon dioxide.
• Skin that looks mottled (patchy red and blue-gray), flushed, and radiating intense heat, with a rapidly rising temperature exceeding 38.8 to 40.0 degrees Celsius (101.8 to 104.0 degrees Fahrenheit).
• Dark brown, reddish, or cola-colored urine caused by dissolving muscle protein (myoglobin).
• Immediate action: Call your local emergency number immediately and state clearly: "The patient had general anesthesia today and has signs of malignant hyperthermia, we need transport to a hospital with intravenous dantrolene." Strip all clothing, mist the skin with cool water, fan vigorously, pack cloth-wrapped ice packs into the neck, armpits, and groin, and never give acetaminophen or ibuprofen. You can also have the hospital team contact the Malignant Hyperthermia Association of the United States (MHAUS) 24-hour hotline at 1-800-644-9737 (or +1-209-417-3722 internationally).

2. Local Anesthetic Systemic Toxicity (LAST) from home pain pumps or nerve blocks¶

Orthopedic and abdominal patients are often discharged home with long-acting peripheral nerve blocks (such as liposomal bupivacaine or ropivacaine) or an elastomeric continuous local anesthetic pain pump (a portable ball-shaped reservoir connected to a thin catheter placed near a nerve or inside the surgical wound). If the catheter migrates into a blood vessel or infuses too rapidly, local anesthetic rises to toxic levels in the brain and heart (LAST):

• Early neurological warning signs: Sudden numbness and tingling around the lips and tongue (perioral paresthesia), a striking metallic taste in the mouth, ringing in the ears (tinnitus), blurry vision, slurred speech, or muscle twitching.
• Late severe signs: Generalized seizures, loss of consciousness, dangerously slow heart rate, or sudden cardiac arrest.
• Immediate action: Immediately clamp the tubing on the home pain pump using the attached plastic pinch clamp (never pull the catheter out of the skin unless instructed), call your local emergency number, tell the dispatcher "Suspected local anesthetic systemic toxicity from a home nerve block pump, the patient needs intravenous 20 percent lipid emulsion therapy," and protect the patient in the recovery position if a seizure begins.

Abdominal wound dehiscence ("burst abdomen") and evisceration¶

Between Post-Operative Day 4 and Day 10 following an abdominal operation (laparotomy, C-section, hernia repair, or bowel resection), the deep connective tissue layer holding the abdominal wall together (the linea alba or rectus fascia) relies entirely on surgical sutures before new collagen scars mature. If sutures pull through edematous fascia, often right after the patient coughs, sneezes, vomits, or strains on the toilet, the deep fascial layer splits open (wound dehiscence).

The classic warning sign: the "salmon-pink fluid gush"¶

Hours before the outer skin stitches or staples actually pop open, patients with deep fascial dehiscence almost always experience a sudden, profuse gush of thin, pinkish-orange watery fluid (historically called serosanguinous "salmon-colored" peritoneal fluid) that abruptly soaks through their abdominal dressing and shirt. Many patients also report feeling or hearing a distinct "pop" or tearing sensation deep inside their belly when coughing.

If the outer skin incision also gives way and dark pink, shiny loops of intestine or yellow fatty omentum protrude through the opening, the complication has progressed to surgical wound evisceration.

Step-by-step first aid for dehiscence and evisceration¶

1. Call emergency medical services immediately and keep the patient strictly NPO (nothing by mouth).
2. Position in the low-Fowler flexed-knee position: Have the patient lie on their back with their head and shoulders propped slightly (15 to 20 degrees) and place two thick pillows underneath their bent knees. Bending the knees and hips relaxes the rectus abdominis muscles and prevents the wound edges from pulling wider apart.
3. Never push protruding bowel or tissue back inside the abdomen: Pushing contaminated organs back inside introduces skin bacteria directly into the peritoneal cavity and can twist or kink the bowel's mesenteric blood supply.
4. Apply a warm, moist sterile dressing: Soak a sterile trauma dressing, unfolded sterile gauze pads, or the cleanest freshly laundered smooth cotton dish towel available in sterile normal saline (from a first aid eyewash bottle) or clean warm tap water that has been boiled and cooled to body temperature. Lay the wet dressing loosely over the open wound or exposed bowel, then cover the wet cloth with a layer of clean plastic food wrap or a clean dry towel to hold in moisture and heat. (If a dry dressing is left on exposed bowel, the delicate serosal membrane dries out, dies, and sticks to the fabric).
5. Splint the belly if coughing: Instruct the patient not to cough or strain; if they cannot suppress a cough, gently support a soft pillow over the wrapped dressing with flat hands.

Fugas intestinales anastomóticas, infeccións do sitio cirúrxico e sepsis postoperatoria¶

Se un paciente foi sometido a unha cirurxía que corta e reconecta calquera parte do tracto dixestivo (anastomose), como resección de colon, bypass gástrico, gastrectomía de manga, apendicectomía, procedemento de Whipple ou reparación do intestino delgado, a articulación recén grapada ou cosida é máis débil entre o día 3 e o día 7. Se ata se desenvolve unha fuga estenopeica (fuga anastomótica), o ácido, a bilis ou as feces cargadas de bacterias filtran na cavidade abdominal estéril, provocando peritonite química e rápida choque séptico.

Como distinguir a curación normal da incisión dunha infección perigosa ou fuga interna¶

• Curación normal esperada: rosa leve que se estende a menos de 5 milímetros (0,2 polgadas) ao redor da liña de grapa ou punto, lixeira calor, exudación serosa lixeira transparente ou amarela pálida durante as primeiras 48 horas e dor que mellora cada día.
• Infección do sitio cirúrxico superficial (chame ao cirurxián hoxe): Vermelhidão (eritema) que se espalla a máis de 1 ou 2 centímetros da incisión, inchazo, calor palpitante e pus groso e opaco de cor amarela, verde ou mal cheiro que drena entre puntos de sutura (normalmente os días 4 a 10). Debuxa unha liña ao longo do bordo exterior do vermelhidão cun bolígrafo e escribe a hora para que os médicos poidan ver a rapidez con que se expande.
• Infección necrotizante de tecidos brandos (chame inmediatamente ao 911/112/999): Aparece tan pronto como 24 a 72 horas despois da cirurxía. O paciente experimenta unha dolor profunda e implacable desproporcionada co aspecto da pel; a pel pode volverse gris púrpura escura, desenvolver burbullas cheas de líquido (bullas), sentirse dura como a madeira ou crepitar como papel de burbullas cando se toca (crepitus subcutáneo de bacterias que producen gases), acompañado de febre alta, mareos e confusión.
• Fuga anastomótica interna/Peritonite (chame inmediatamente ao 911/112/999): A miúdo a incisión da pel externa parece completamente limpa e seca, pero entre o día 3 e o día 8 o paciente desenvolve:
• Unha frecuencia cardíaca en repouso persistente superior a 100 a 110 latexos por minuto (moitas veces precede á febre de 12 a 24 horas).
• Egravamento da dor abdominal que sacude bruscamente cando se golpea a cama ou cando tose (tenrura de rebote/protección).
• ** Hipo persistente **, náuseas, incapacidade para pasar gases ou vómitos biliosos de cor verde escuro/marrón.
• Nova confusión, somnolencia, fala confusa, escalofríos (rigor), pel moteada ou saída de orina nula durante 12 horas (características do shock séptico).

Coágulos sanguíneos postoperatorios (TVP e EP) e comprobacións de hematoma espiñal¶

Durante as dúas primeiras semanas, deben realizarse dúas comprobacións finais despois da alta todos os días na casa:

1. Trombose venosa profunda (TVP) e embolia pulmonar (EP): A cirurxía desencadea a hipercoagulabilidade (sangue pegajoso) mentres que a recuperación reduce a marcha. Compare os tenreiros e os nocellos a diario: se unha perna se incha, aperta, quente, vermella ou tenra na pantorrilla, non masaxe a perna (a masaxe pode soltar o coágulo). Se o paciente de súpeto desenvolve falta de aire en repouso, dor no peito aguda ao respirar, tose sangue, pulso acelerado ou desmaio, chame inmediatamente ao seu número de emerxencia local por sospeita de embolia pulmonar.
2. Hematoma espinal ou epidural (despois da anestesia espinal, analxesia epidural ou cirurxía da columna): Unha vez que un bloqueo espinal ou epidural desaparece (dentro de 4 a 6 horas), a forza e sensación total en ambas as pernas e o control normal da vexiga deben volver e manterse normal. Se un paciente na casa desenvolve dor de costas grave e empeorando na liña media acompañado de novo entumecimiento ou formigueo na ingle/nádegas ("anestesia de sela"), debilidade progresiva ou pesadez nas pernas, ou incapacidade para orinar/incontinencia, o sangue está comprimindo a medula espiñal (compresión cauda equina). Chame inmediatamente aos servizos de emerxencia; A descompresión cirúrxica debe producirse nun prazo de 6 a 8 horas para evitar a parálise permanente.

Preguntas frecuentes¶

Fontes comprobadas¶

• Colegio Americano de Cirurxiáns (ACS, Estados Unidos): Recursos óptimos para a calidade e seguridade cirúrxicas, Directrices de coidados domiciliarios posoperatorios e Protocolos de control de hemorraxias de parar.
• Organización Mundial da Saúde (OMS, Internacional): Directrices mundiais para a prevención da infección do sitio cirúrxico e Lista de verificación de seguridade cirúrxica da OMS Estándares de clasificación postoperatoria.
• Asociación de Hipertermia Maligna dos Estados Unidos (MHAUS) e Grupo Europeo de Hipertermia Maligna (EMHG): Recoñecemento clínico e tratamento de emerxencia da hipertermia maligna postoperatoria aguda e retardada.
• Sociedade Americana de Anestesia Rexional e Medicina da Dor (ASRA, Estados Unidos): Lista de verificación para o tratamento da toxicidade sistémica por anestesia local (LAST) e Directrices de vixilancia do hematoma espinal/epidural.
• Difficult Airway Society (DAS), British Association of Endocrine and Thyroid Surgeons (BAETS) e National Institute for Health and Care Excellence (NICE, Reino Unido): Multidisciplinary Guidelines for the Management of Post-Operative Heemorrhage After Thyroid Surgery (Protocolo SCOOP) e Sepsis Recognition (NG51).

Guías relacionadas¶

• Evisceración abdominal e coidado de feridas de estómago aberto
• Recoñecemento e primeiros auxilios de sepsis e choque séptico
• Triaxe da embolia pulmonar e da trombose venosa profunda (TVP).
• Control de hemorraxias e hemorraxias graves
• Primeiros auxilios de choque e colapso circulatorio
• Números de emerxencia por país