Surgery annual
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The respiratory failure that develops in surgical patients is usually caused by a surgical problem--shock, trauma, sepsis, pulmonary contusion, aspiration, pulmonary emboli or pain, with its attendant ventilatory compromise. Although the underlying pathophysiology for the respiratory failure in these conditions is not precisely known, the means for prevention are well known. ⋯ The respiratory failure of sepsis is best treated by seeking out foci of pus or devitalized tissue and surgically ablating these foci when found. Adherence to these basic surgical principles--aggressive resuscitation of patients in shock and prompt attention to their surgical problems--will alleviate much of the respiratory distress of surgical patients, no matter what the pathophysiology or etiology may be.
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The thrombelastogram as designed by Hartert has now been in use for more than 30 years. Within 30 minutes, it provides a global account of clot formation and fibrinolysis or the time and degree of the interaction between the activators and inhibitors of both systems. On the basis of our own experience, it seems justifiable to assert that although its sensitivity to technical variables requires stringent laboratory control, the TEG offers a simple, reliable method of defining the key areas of hemostatic incompetence or for assessing the efficacy of a therapeutic program. Thrombelastographic hypercoagulability, which has deservedly been given prominence in the recent literature, may add an exciting dimension to the diagnostic spectrum of an elegantly conceived instrument.