Cirugía española
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In patients with traumatic intraabdominal hemorrhage, urgent decisions must be made. Resuscitation measures must often be simultaneously combined with diagnostic actions and measures to control the source of the bleeding. Hemorrhages are usually complicated by coagulation disorders and the presence of acidosis and hypothermia. ⋯ These guidelines review aspects such as evaluation and initial management of bleeding, localization and control of the source of bleeding and replacement of blood products. In addition, recommendations based on the best available evidence to 2008 are made. This review describes the basic aspects of traumatic intraabdominal hemorrhage.
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Editorial Review
[Permissive hypotension in resuscitation of trauma patients].
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Perioperative management is one of the fields of surgery most hide bound by tradition and conventional attitudes are difficult to modify even in the face of strong scientific evidence. One of the advances that has most helped to improve the results of colorectal surgery is multimodal or fast-track rehabilitation, which aims to enhance recovery, reduce morbidity, and shorten the length of hospital stay. ⋯ Other factors that can also reduce complications are epidural analgesia, avoidance of drainage and nasogastric decompression, early oral feeding, and minimally invasive surgery. There is strong evidence that the combined use of these and other measures enhances postsurgical recovery, although many of these measures are currently little used in daily practice.
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Although the high mortality rate from infectious causes in asplenic patients has been well known since the beginning of the twentieth century, rates of antibiotic prophylaxis in these patients continue to be worryingly low. Consequently, we reviewed the causes of these high mortality rates with a view to recommending preventive measures. The attitude to prophylaxis in these patients depends on age and the cause of splenectomy both in vaccination and antibiotic prophylaxis. The immune status of these patients is decisive in antibiotic prophylaxis, as this treatment will differ in patients splenectomized after a traffic accident and in those splenectomized for lymphoma.
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The use of analgesics during the diagnosis and decision-making process in patients with acute nontraumatic abdominal pain is controversial. The aim of the present study was to determine whether the use of opioid analgesics in patients with acute nontraumatic abdominal pain increases the risk of diagnostic error. ⋯ The use of opioid analgesics in patients with acute nontraumatic abdominal pain does not increase the risk of diagnostic error and reduces pain during the decision-making process.