Trauma and Post-OP Management

Compartment syndrome is a surgical emergency usually occurring secondary to trauma. The condition is marked by increased pressure within a compartment that compromises the circulation and function of the tissues within that space. Long bone fractures are the most common cause, with the leg and forearm compartments frequently affected. Patients present with pain out of proportion to the injury and may also have pallor, pulselessness, paresthesia, poikilothermia, and paralysis (the 6 Ps of compartment syndrome). Diagnosis is clinical but compartment pressure measurement can be used. Management is an emergency fasciotomy. Failure to diagnose and manage the condition results in limb loss.

A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Clinical presentation varies depending on the cause and location of the injury, but generally includes deformity, pain, edema, and inflammation. Diagnosis is made clinically and confirmed with imaging, and management may be with splinting or may require surgery.

After any procedure performed in the operating room, all patients must undergo close observation at least in the recovery room. After larger procedures and for patients who require hospitalization, observation must continue on the surgical ward. The primary intent of this practice is the early detection of postoperative complications. The entire medical team must be vigilant and aware of the patient’s history, the procedure performed, and risk factors for potential complications. Some of the most important things to attend to include monitoring vital signs (which may indicate severe complications such as bleeding), wound and drain care, postoperative pain control, nausea and vomiting, pulmonary hygiene to prevent atelectasis, deep vein thrombosis prophylaxis, and fluid management.

Local anesthetics are a group of pharmacological agents that reversibly block the conduction of impulses in electrically excitable tissues. Local anesthetics are used in clinical practice to induce a state of local or regional anesthesia by blocking sodium channels and inhibiting the conduction of painful stimuli via afferent nerves. The effects of local anesthetics are influenced by their physicochemical properties such as lipid solubility and protein binding, as well as nerve anatomy and local tissue conditions. Adverse events, interactions, and contraindications vary depending on the agent that is used.

A burn is a type of injury to the skin and deeper tissues caused by exposure to heat, electricity, chemicals, friction, or radiation. Burns are classified according to their depth as superficial (1st-degree), partial-thickness (2nd-degree), full-thickness (3rd-degree), and 4th-degree burns. Management is greatly dependent on the extent of surface area affected and the depth of the burns. Management involves fluid resuscitation, adequate analgesia, and appropriate wound care with the goal of preventing opportunistic infection.