While recovering on the surgical ward six days after an emergency laparotomy for a perforated duodenal ulcer, a patient experiences a sudden 'popping' sensation in his abdomen during an intense coughing spell. The evaluating nurse notes that the surgical staples have separated, and segments of the small intestine are visibly protruding through the fascial defect onto the skin surface. The patient is tachycardic but maintaining his airway. Arrange the following medical interventions in the correct chronological order to appropriately manage this acute complication.
- 1Cover the exposed viscera with sterile, saline-moistened dressings.
- 2Position the patient supine with hips and knees flexed.
- 3Establish intravenous access for fluid resuscitation and antibiotic administration.
- 4Transport the patient to the operating room for emergent fascial closure.
Cevap
First, cover the exposed viscera with sterile saline-moistened dressings, then position the patient supine with hips and knees flexed, followed by establishing intravenous access for fluids and antibiotics, and finally transport the patient to the operating room.
Wound evisceration is a surgical emergency characterized by the protrusion of intra-abdominal organs through a dehisced surgical incision. The immediate priority is organ preservation; therefore, the first step is to cover the exposed bowel with sterile, saline-soaked dressings to prevent desiccation and ischemic damage. Once protected, the patient should be placed in a supine position with the hips and knees flexed to relax the abdominal musculature and reduce intra-abdominal pressure, thereby preventing further extrusion. After stabilizing the local wound environment, systemic preparation for surgery must occur, which includes establishing intravenous access for crystalloid resuscitation and administering broad-spectrum antibiotics to mitigate the risk of sepsis. Finally, once immediate temporizing measures are complete, the patient must be rapidly transported to the operating room for definitive fascial closure.
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Anahtar Kavram
Management of postoperative wound evisceration requires immediate bedside protection of the exposed viscera with moist dressings, tension-reducing positioning, systemic resuscitation, and prompt surgical closure.