On the 4th postoperative day of laparotomy a patient presents with bleeding & oozing from the wound management is
GENERAL POSTOPERATIVE COMPLICATIONS Bleeding Postoperative haemorrhage is most common in the immediate postoperative period. It may be caused by an aerial or venous leak, but also by a generalised ooze or a coagulopathy. Slow bleeds may go undetected for hours and then the patient suddenly decompensates. All patients must have their vital signs (pulse rate, blood pressure, oximetry, central venous pressure, if available, and urine output) monitored regularly. Dressings and drains should be inspected regularly in the first 24 hours after surgery. If haemorrhage is suspected, blood samples should be taken for a full blood count, coagulation profile and cross match. A large bore intravenous cannula should be sitedand fluid resuscitation commenced. If the source of bleeding is in doubt and the patient is stable, an ultrasound or computed tomography (CT) scan may be required to determine the nature of the bleed (most commonly if a haematoma is suspected in the days following surgery). If the patient's cardiovascular system is unstable or compromised in any way (for example neck haematoma or bleeding tonsil) they should be taken back to the operating theatre immediately. The treatment of haemorrhage is both to stop the bleeding and suppoive. Suppoive treatment includes oxygen and fluid resuscitation. It may require correction of coagulopathy. All patients will require close observation. Blood transfusion carries risks (acute haemolytic transfusion reaction, sensitisation, fluid overload, hyperkalaemia, transfusion-related lung injury and transmission of blood-borne infection). There is much published about what is the right transfusion trigger and how to balance the need for adequate tissue perfusion and the risks of transfusion. The decision about when to transfuse should be based on the individual patient; in general, however, the accepted transfusion trigger is 75 g/L except in the presence of known or suspected coronary aery disease when a higher trigger is acceptable. All hospitals should have a 'major haemorrhage protocol' in place. The consultant surgeon, anaesthetist and haematologist should all be involved early on in the care of unstable patients. Ref : Bailey and love 27th edition Pgno : 296
Dressing of wound & observe for dehiscence
IV fluids
Send for USG abdomen
Sta treatments for peritonitis
Urology