Pelepasan Bendera Merah Selepas Pembedahan, Pendarahan Dalaman dan Jangkitan¶

Lebih daripada 65 peratus prosedur pembedahan di seluruh dunia kini dilakukan secara ambulatori (pesakit luar) atau pelepasan cepat, bermakna berjuta-juta pesakit pulih daripada anestesia am, blok tulang belakang, laparoskopi, akses vaskular dan pembedahan ortopedik atau abdomen di dalam rumah mereka sendiri dalam beberapa jam selepas meninggalkan bilik pembedahan. Walaupun kebanyakan kesakitan selepas pembedahan, loya ringan dan lebam gred rendah hilang dengan lancar, 14 hari pertama selepas pembedahan membawa tingkap akibat tinggi untuk pendarahan dalaman yang tersembunyi, hematoma saluran pernafasan yang meluas, hipertermia malignan yang tertunda, penyahisan luka abdomen (perut pecah), emboli kebocoranbopul** sepsis**.

Keutamaan segera anda semasa menjaga pesakit pembedahan yang baru keluar dari hospital yang merosot di rumah adalah untuk membezakan pemulihan pembedahan yang dijangkakan daripada kecemasan pembedahan yang mengancam nyawa, memanggil perkhidmatan perubatan kecemasan sebelum renjatan menjadi tidak dapat dipulihkan, memastikan perut pesakit benar-benar kosong (tiada melalui mulut) sekiranya pemulangan segera ke bilik pembedahan atau saluran udara diperlukan, melindungi struktur yang terdedah kepada pembedahan dan melancarkan semula struktur yang terdedah. dokumentasi kepada paramedik.

Lakukan ini sekarang¶

1. Hubungi perkhidmatan perubatan kecemasan dengan segera untuk sebarang tanda pasca operasi yang mengancam nyawa: Hubungi nombor kecemasan tempatan anda (911 di Amerika Syarikat dan Kanada, 112 di seluruh Kesatuan Eropah, 999 di United Kingdom, 000 di Australia) atau semak direktori kami nombor kecemasan jika pesakit mengalami sesak nafas, sakit dada, pengsan, pening apabila duduk, darah merah terang berendam melalui pembalut, leher bengkak dengan cepat selepas pembedahan tiroid atau karotid, otot tegar dengan demam yang meningkat, atau hirisan perut yang terbuka.
2. Kuatkuasakan NPO yang ketat (tiada apa-apa melalui mulut) dengan segera: Jangan berikan pesakit air, cip ais, makanan atau ubat sakit mulut sebaik sahaja komplikasi pembedahan disyaki. Jika pesakit mesti dikejarkan semula ke pembedahan untuk menghentikan pendarahan dalaman atau membaiki kebocoran usus, mempunyai air atau makanan di dalam perut berisiko aspirasi maut semasa induksi anestesia am kecemasan.
3. Baringkan pesakit secara mendatar kerana disyaki pendarahan dalaman atau kejutan: Jika pesakit pucat, sejuk, lembap, pening, atau tachycardic (denyutan jantung melebihi 100 degupan seminit semasa rehat), baringkan mereka rata di belakang mereka dan angkat kaki mereka 15 hingga 30 sentimeter (6 hingga 12 inci) melainkan jika ketinggian kaki atau orthopedic menyebabkan abdominal.
4. Sapukan tekanan langsung yang kuat ke atas pendarahan pembedahan luar (kecuali pada tenggorokan): Jika darah merah terang meresap melalui pembalut pembedahan pada anggota badan, payudara, pangkal paha atau perut, jangan tanggalkan lapisan bawah kain kasa; susun bersih, keringkan tuala yang dilipat atau kain kasa terus di atas dan tekan ke bawah dengan kuat dengan kedua-dua tangan.
5. Tutup hirisan perut yang terbuka (dehiscence) dengan pembalut basah steril: Jika jahitan atau staples pembedahan hilang dan cecair merah jambu atau gelung usus muncul di dalam luka, jangan sekali-kali menolak organ ke dalam. Tutup luka terbuka dengan longgar dengan tuala bersih atau kain kasa steril yang direndam dalam garam steril atau air paip suam yang bersih, dan bengkokkan lutut pesakit sedikit di atas bantal untuk menghilangkan ketegangan pada dinding perut.
6. Kumpulkan paket pelepasan pembedahan dan rekod anestesia: Paramedik tangan ringkasan keluar hospital, nombor telefon panggilan kecemasan 24 jam pakar bedah, kad implan pembedahan (jika perkakasan atau jaringan diletakkan), dan semua ubat pencair darah dan ubat penahan sakit yang ditetapkan.

flowchart TD
    Start["Pesakit Selepas Pembedahan Merosot di Rumah (Jam hingga 14 Hari Selepas Keluar)"] --> Triage{"1. Kenal pasti Corak Kecemasan Utama"}
    Triage -->|Shortness of Breath, Chest Pain, or Neck Swelling| AirwayPE["Krisis Saluran Udara / Vaskular: Hubungi 911/112/999, Duduk Tegak, Periksa Hematoma Leher Mengembang atau Embolisme Pulmonari"]
    Triage -->|Pale, Sweaty, Dizzy, Heart Rate Over 100, or Expanding Belly/Thigh| Bleed["Pendarahan Dalaman atau Luaran: Hubungi 911/112/999, Baring Rata, Tekan Tegas Pada Pendarahan Luaran, Simpan NPO"]
    Triage -->|Jaw/Muscle Stiffness, Rapid Fever Over 38.8 C, Dark Urine Within 24 Hours| MH["Suspek Tertunda Hipertermia Malignan: Hubungi 911/112/999, Strip Pakaian, Kabus dan Kulit Kipas, Pek Ais ke Pangkal paha/Leher"]
    Triage -->|Pink Salmon Fluid Gush from Belly Incision or Bowel Visible| Dehisce["Dehiscence Luka / Pembuangan: Hubungi 911/112/999, Tutup dengan Tuala Bersih Lembap Hangat, Bengkokkan Lutut Atas Bantal"]
    Triage -->|Fever, Confusion, Shivering Chills, or Worsening Belly Pain Day 3 to 10| Sepsis["Suspek Anastomosis Bocor atau Sepsis: Hubungi 911/112/999 atau Pakar Bedah Segera, Jangan Simpan Apa-apa melalui Mulut"]
    AirwayPE --> NPO["2. Menguatkuasakan NPO yang Ketat (Tiada Air, Makanan, atau Pil Mulut) dalam Kes Operasi Semula Segera"]
    Bleed --> NPO
    MH --> NPO
    Dehisce --> NPO
    Sepsis --> NPO
    NPO --> Docs["3. Kumpul Ringkasan Pelepasan Pembedahan, Rekod Anestesia dan Semua Botol Ubat untuk EMS"]

Garis masa komplikasi selepas pembedahan: apabila krisis tertentu berlaku¶

Komplikasi pembedahan mengikut garis masa biologi yang boleh diramal berdasarkan hemostasis, metabolisme anestetik, kekuatan tegangan luka dan replikasi bakteria. Memahami hari mana pesakit berada ("Hari Selepas Pembedahan 0" ialah hari pembedahan) membantu penjaga mengenali apa yang gagal di dalam badan.

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.

Pendarahan sekunder selepas tonsilektomi (Hari 5 hingga 14)¶

Kanak-kanak dan orang dewasa yang menjalani tonsilektomi membentuk kudis fibrinous putih-kelabu tebal (eschar) di atas katil tonsil di dalam bahagian belakang tekak. Antara Hari 5 Selepas Operasi dan Hari 10, apabila kulit mukosa baru tumbuh di bawahnya, kudis ini mengelupas. Dalam 2 hingga 5 peratus pesakit, kudis mengelupas sebelum waktunya dan membuka cawangan asas arteri karotid luaran.

• Pertolongan cemas semasa pendarahan tonsilektomi aktif:
• Hubungi nombor kecemasan tempatan anda dengan segera.
• Pastikan kanak-kanak atau orang dewasa duduk tegak dan condong ke hadapan di atas mangkuk atau sinki supaya mereka boleh memuntahkan semua darah keluar dari mulut mereka. Galakkan mereka untuk tidak menelan darah, kerana darah yang ditelan menyembunyikan jumlah sebenar kehilangan darah dan mencetuskan muntah ganas yang menghilangkan bekuan darah.
• Jika pesakit berjaga-jaga sepenuhnya dan memberi kerjasama, minta mereka menghanyut dan meludah perlahan air sejuk atau menghisap serpihan ais yang dihancurkan (hanya jika terjaga dan tidak tercekik) sambil memegang pek ais yang dibalut kain pada belakang luar dan tepi leher membantu menyempitkan saluran darah tekak sehingga paramedik tiba.
• 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.

Hipertermia malignan tertunda dan ketoksikan sistemik anestetik tempatan (TERAKHIR)¶

Walaupun kebanyakan kecemasan berkaitan anestesia berlaku di dalam bilik pemulihan hospital, pelepasan pesakit luar yang cepat bermakna penjaga mesti mengenali dua tindak balas selepas anestesia kritikal yang boleh berlaku di rumah dalam tempoh 12 hingga 24 jam pertama.

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

Hipertermia malignan (MH) ialah gangguan farmakogenetik warisan saluran kalsium otot rangka (kebiasaannya gen RYR1). Apabila seseorang yang mudah terdedah kepada MH terdedah kepada anestetik am penyedutan yang meruap (sevoflurane, desflurane, isoflurane) atau pelemas otot yang menyahkutub succinylcholine, kalsium melimpah secara tidak terkawal dari retikulum sarcoplasmic ke dalam gentian otot. Otot mengunci ke dalam pengecutan berterusan, mengambil oksigen, menghasilkan sejumlah besar karbon dioksida dan asid laktik, dan memacu suhu badan teras ke atas pada kadar 1 darjah Celsius (1.8 darjah Fahrenheit) setiap 5 minit.

Walaupun 90 peratus daripada krisis MH bermula semasa pembedahan atau dalam masa 1 jam selepas pemberhentian anestesia, MH selepas pembedahan boleh merebak beberapa jam selepas pesakit pulang ke rumah selepas pembedahan pesakit luar, atau pesakit yang mengalami reaksi ringan dan tidak dikenali semasa pembedahan mungkin mengalami fulminan rhabdomyolysis pada petang itu.

• Bendera merah hipertermia malignan selepas anestesia:
• 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.

Kebocoran usus anastomosis, jangkitan tapak pembedahan, dan sepsis selepas operasi¶

Jika pesakit menjalani pembedahan yang memotong dan menyambung semula mana-mana bahagian saluran penghadaman (anastomosis), seperti reseksi kolon, pintasan gastrik, gastrectomy lengan, appendectomy, prosedur Whipple, atau pembaikan usus kecil, sendi yang baru dikokot atau dijahit adalah paling lemah antara Hari 3 dan Hari 7. Jika kebocoran lubang jarum berlaku (kebocoran anastomotik), asid, hempedu atau najis sarat bakteria meresap ke dalam rongga perut steril, mencetuskan peritonitis kimia dan cepat renjatan septik.

Bagaimana untuk membezakan penyembuhan hirisan biasa daripada jangkitan berbahaya atau kebocoran dalaman¶

• Dijangkakan penyembuhan normal: Kemerahan merah jambu lembut memanjang kurang daripada 5 milimeter (0.2 inci) di sekeliling garisan koil atau jahitan, sedikit kehangatan, serous kuning jernih atau kuning pucat yang meleleh sepanjang 48 jam pertama dan rasa sakit yang berterusan berbaik setiap hari.
• Jangkitan Tapak Pembedahan Superficial (Hubungi pakar bedah hari ini): Kemerahan (eritema) merebak lebih lebar daripada 1 hingga 2 sentimeter dari hirisan, bengkak, panas berdenyut dan nanah tebal, kuning legap, hijau atau berbau busuk yang mengalir dari celah-celah jahitan (biasanya Hari 4 hingga 10). Lukis garisan di sepanjang tepi luar kemerahan dengan pen dan tulis masa supaya doktor dapat melihat betapa cepatnya ia berkembang.
• Jangkitan Tisu Lembut Necrotizing (Hubungi 911 / 112 / 999 dengan segera): Muncul seawal 24 hingga 72 jam selepas pembedahan. Pesakit mengalami sakit dalam yang luar biasa, tanpa henti daripada semua perkadaran dengan rupa kulit; kulit mungkin bertukar menjadi kelabu ungu kehitaman, membentuk lepuh berisi cecair (bullae), berasa keras kayu, atau berderak seperti balutan gelembung apabila disentuh (krepitasi subkutan daripada bakteria penghasil gas), disertai dengan demam panas, pening dan kekeliruan.
• Kebocoran Anastomosis Dalaman / Peritonitis (Hubungi 911 / 112 / 999 dengan segera): Selalunya hirisan kulit luar kelihatan bersih dan kering sepenuhnya, tetapi antara Hari 3 dan Hari 8 pesakit berkembang:
• Kadar jantung berehat berterusan melebihi 100 hingga 110 denyutan seminit (selalunya mendahului demam selama 12 hingga 24 jam).
• Sakit perut yang semakin teruk yang tersentak secara mendadak apabila katil terhantuk atau apabila mereka batuk (rebound kelembutan / menjaga).
• Sengguk berterusan, loya, ketidakupayaan untuk mengeluarkan gas, atau muntah bilious hijau tua/coklat.
• Kekeliruan baru, mengantuk, pertuturan tidak jelas, menggigil menggigil (kekerasan), kulit berbintik-bintik, atau sifar pengeluaran air kencing selama 12 jam (tanda renjatan septik).

Gumpalan darah selepas pembedahan (DVT dan PE) dan pemeriksaan hematoma tulang belakang¶

Dua semakan akhir selepas pelepasan mesti dilakukan setiap hari dalam dua minggu pertama di rumah:

1. Trombosis Urat Dalam (DVT) dan Embolisme Pulmonari (PE): Pembedahan mencetuskan hiperkoagulasi (darah melekit) manakala pemulihan mengurangkan berjalan. Bandingkan kedua-dua betis dan buku lali setiap hari: jika satu kaki bengkak, ketat, hangat, merah atau lembut di betis, jangan urut kaki (mengurut boleh memecahkan bekuan darah). Jika pesakit tiba-tiba mengalami sesak nafas semasa berehat, sakit dada yang tajam apabila menarik nafas, batuk darah, nadi berlumba-lumba, atau pengsan, hubungi nombor kecemasan tempatan anda dengan segera untuk mengesyaki embolisme pulmonari.
2. ** Hematoma tulang belakang atau Epidural (Selepas anestesia tulang belakang, analgesia epidural, atau pembedahan tulang belakang):** Sebaik sahaja blok tulang belakang atau epidural hilang (dalam masa 4 hingga 6 jam), kekuatan dan sensasi penuh pada kedua-dua kaki dan kawalan pundi kencing yang normal mesti kembali dan kekal normal. Jika pesakit di rumah mengalami sakit belakang garis tengah yang teruk dan semakin teruk disertai dengan kebas atau kesemutan baru di pangkal paha/punggung ("anesthesia pelana"), kelemahan atau berat secara progresif di kaki, atau ketidakupayaan untuk membuang air kecil / inkontinensia, darah sedang memampatkan saraf tunjang (cauda equina compression). Hubungi perkhidmatan kecemasan dengan segera; penyahmampatan pembedahan mesti berlaku dalam masa 6 hingga 8 jam untuk mengelakkan lumpuh kekal.

Soalan lazim¶

Sumber disemak¶

• American College of Surgeons (ACS, United States): Optimal Resources for Surgical Quality and Safety, Post-Operative Home Care Guidelines, and Stop the Bleed Hemorrhage Control Protocols.
• Pertubuhan Kesihatan Sedunia (WHO, Antarabangsa): Garis Panduan Global untuk Pencegahan Jangkitan Tapak Pembedahan dan Senarai Semak Keselamatan Pembedahan WHO Piawaian Triage Selepas Pembedahan.
• Malignant Hyperthermia Association of the United States (MHAUS) and European Malignant Hyperthermia Group (EMHG): Clinical Recognition and Emergency Treatment of Acute and Delayed Post-Operative Malignant Hyperthermia.
• Persatuan Anestesia Serantau dan Perubatan Sakit Amerika (ASRA, Amerika Syarikat): Senarai Semak untuk Rawatan Toksisiti Sistemik Anestetik Tempatan (TERAKHIR) dan Garis Panduan Pengawasan Hematoma Tulang Belakang/Epidural.
• Difficult Airway Society (DAS), British Association of Endocrine and Thyroid Surgeons (BAETS), and National Institute for Health and Care Excellence (NICE, United Kingdom): Multidisciplinary Guidelines for the Management of Post-Operative Haemorrhage After Thyroid Surgery (SCOOP Protocol) and Sepsis Recognition (NG51).

Panduan berkaitan¶

• Pembuangan perut dan penjagaan luka perut terbuka
• Pengecaman sepsis dan kejutan septik dan pertolongan cemas
• Triage embolisme pulmonari dan trombosis urat dalam (DVT).
• Pendarahan yang teruk dan kawalan pendarahan
• Kejutan dan peredaran darah runtuh pertolongan cemas
• Nombor kecemasan mengikut negara