Who's Online
0 registered (), 10 Guests and 1 Spider online.
Key: Admin, Global Mod, Mod
Forum Stats
6849 Members
13 Forums
3401 Topics
13101 Posts

Max Online: 175 @ 09/26/12 04:59 PM
Medword Picks

Topic Options
#15818 - 02/09/12 11:06 PM help on exam#21 from USCI
aweimer Offline
Newbie Gabber

Registered: 02/03/12
Posts: 4
Loc: Maryland
Name: James Floyd OPERATIVE REPORT
#050123 Date of Operation: 02/3/2012
Surgeon: Anne Jones Department: General Surgery
Assistant Surgeons: D. Patel, MD, A. Ibrahami, MD

OPERATIVE REPORT

PREOPERATIVE DIAGNOSIS
Gunshot wound to the right flank.

POSTOPERATIVE DIAGNOSIS
Gunshot wound to the right flank with injury to the right kidney.

PRIMARY PROCEDURE
Exploratory celiotomy.

SECONDARY PROCEDURE
Right nephrectomy.

ANESTHESIA
General endotracheal.

FINDINGS
Large right retroperineal hematoma, approximately 1-liter and 500 ccs clotted blood in the abdominal cavity. Active arterial bleeding, right kidney, right renal fracture, serosal tear, right mesocolon above the secant. Bullet wound, right psoas muscle.

PROCEDURE
The patient was brought to the operating room and placed on the table in the spine position. The abdomen was quickly shaved, prepped and draped in the usual sterol fashion. A mid-line incision was made down the linea alba, from the sideway process down to the umbilicus using a number 10 scalpel. The linea alba was sharply incised with a scalpel and the preperitoneal fat was swept to one side. The peritoneum was then identified, clamped between two Kelly clamps and sharply incised allowing access to the peritoneal cavity under direct visualization. On entering the abdomen, there was approximately 500 ccs of clotted blood noted within abdominal cavity and a rapidly expanding large right retroperitoneal hematoma. The right colon was immobilized quickly by incising the peritoneal reflection to the right of the right colon it was immobilized to the mid-line. Upon entering the right retroperitoneal hematoma approximately 1-liter of clot were removed, arterial bleeding was noted to be coming from the right kidney. The gunshot wound had entered the right flank and had traversed from the inferior pole of the right kidney to the hilum of the right kidney fracturing the right kidney into pieces with active arterial bleeding coming from the superior half. The right renal vein and artery were dissected clear and ligated, the right ______ was then ligated using 2-o silk suture. A clip was also placed over the right ______. The right kidney was mobilized from its fossa and removed from the field. Small bleeders were controlled with clips or the use of 2-o silk suture. Serosal tear in the right mesolcolon above the cecum was implicated using 3-o silk sutures in the seromuscular layer. Old blood was then removed. The abdomen was _____ irrigated with approximately 5-liters of normal saline. A Jackson-Pratt drain was placed in the back of the right kidney threw a separate incision in the right flank. The abdomen was closed using interruptive number one nylon sutures to the fascia. Skin staples were used to reapproximate the skin edges. The patient tolerated the procedure well. The patient was left incubated and sent back to the intensive care unit for further post-operative care. Sponge and instrument count correct. Estimated blood loss 3-liters. Complications: none.



I just need someone to go over it because i have been having a lot of problems with the past few tests and that is how i found this website. It seems like it is a lot of help and it will be nice to have other students to study with and chat with while taking this course. Thank you!!!!

Angela

Top
#15819 - 02/10/12 12:24 AM Re: help on exam#21 from USCI [Re: aweimer]
cherry Offline
Gabber

Registered: 11/30/11
Posts: 21
Loc: MI
Here what I have for your Angela. Hope it will help.

Name: Floyd James OPERATIVE REPORT
#050123 Date of Operation: January 10, 2012
Surgeon: A. Jones, MD Department: General Surgery
Assistant Surgeons: D. Patel, MD, A. Ibrahami, MD
OPERATIVE REPORT
PREOPERATIVE DIAGNOSIS
Gunshot wound to the right flank with injury to the right kidney.
PRIMARY PROCEDURE
EXPLORATORY CELIOTOMY.
SECONDARY PROCEDURE
RIGHT NEPHRECTOMY.
ANESTHESIA
General endotracheal.
FINDINGS
Large right retroperitoneal hematoma, approximately 1 L and 500 mL clotted blood in the abdominal cavity. Active arterial bleeding, right kidney. Right renal fracture. Serosal tear, right mesocolon above the cecum. Bullet wound, right psoas muscle.
PROCEDURE
The patient was brought to the operating room and placed on the table in the supine position. The abdomen was quickly shaved, prepped and draped in the usual sterile fashion. A midline incision was made down the linea alba from the xiphoid process down to the umbilicus using a #10 scalpel. The linea alba was sharply incised with a scalpel, and the preperitoneal fat was swept to one side. The peritoneum was then identified, clamped between two Kelly clamps, and sharply incised allowing access to the peritoneal cavity under direct visualization. On entering the abdomen, there was approximately 500 mL of clotted blood noted within the abdominal cavity and a rapidly expanding large right retroperitoneal hematoma. The right colon was mobilized quickly by incising the peritoneal reflection to the right of the right colon. It was mobilized to the midline. Upon entering the retroperitoneal hematoma, approximately 1 L of clot was removed. Arterial bleeding was noted to be coming from the right kidney. The gunshot wound had entered the right flank and had traversed from the inferior pole of the right kidney to the hilum of the right kidney, fracturing the right kidney in two pieces with active arterial bleeding coming from the superior half. The right renal vein and artery were dissected clear and ligated. The right ureter was then ligated using 2-0 silk suture. A clip was also placed over the right ureter. The right kidney was mobilized from its fossa and removed from the field.
CONTINUED
Name: Floyd James OPERATIVE REPORT
#050123 Page 2
OPERATIVE REPORT
Small bleeders were controlled with clips or the use of 2-0 silk suture. Serosal tear in the right mesocolon above the cecum was imbricated using 3-0 silk sutures in the seromuscular layer. Old blood was then removed. The abdomen was copiously irrigated with approximately 5 L of warm normal saline. A Jackson-Pratt drain was placed in the bed of the right kidney through a separate incision in the right flank. The abdomen was closed using interrupted #1 nylon sutures to the fascia. Skin staples were used to reapproximate the skin edges. The patient tolerated the procedure well. The patient was left intubated and sent back to the intensive care unit for further postoperative care. Sponge and instrument count correct. Estimated blood loss: 3 L. Complications: None.

Top
#15823 - 02/10/12 10:33 PM Re: help on exam#21 from USCI [Re: cherry]
aweimer Offline
Newbie Gabber

Registered: 02/03/12
Posts: 4
Loc: Maryland
Thank you so much! I really appreciate the help. I was able to go back and listen to the media and see what i had wrong through out my exam.

Thank again!!
Ang

Top
#15825 - 02/11/12 10:45 AM Re: help on exam#21 from USCI [Re: aweimer]
cherry Offline
Gabber

Registered: 11/30/11
Posts: 21
Loc: MI
your welcome. Happy that this helped you. Let me know how u did in this exam.

cherry

Top


Moderator:  SOMara 
Social Networking / Browsers

Download Browser:
Download Microsoft Internet ExplorerDownload SafariDownload FirefoxDownload Chrome
Medword space gif

Top Posters
kkb 1552
SOMara 1307
cmt 833
judymae 471
Lakelife 447
Shout Box

(Views)Popular Topics
At-Home Professions course? 11720906
Allied School Study Buddies 220064
Introduce myself 215577
AHP GRADS - WORKING? 148639
Quiz 30 -AHP 104625
At Home Professions - Quiz 30 68750
At-Home Professions course? 63366
Current List of medications 59987
Pet Peeves 56459
What are your 5 favorite movies of all time? 50262