As the saying goes, an orthopedic surgeon can operate and prescribe “Medicine“. A good surgery requires not only the surgeon’s skillful surgical skills, but also perfect perioperative management. Today, 6 common misconceptions about perioperative rehydration in orthopedic surgery should be pushed, which should not be ignored.
- The content of rehydration is covered in the general surgery section, and only general surgeons have mastered or are proficient in it, while other surgeons are not good at it, so they can be consulted if necessary.
This view is self-evidently wrong, and dare I say there have definitely been adverse consequences, even death, although the conclusion of the final event is not always correctly attributed to it.
- Rehydration is the input of saline or glucose.
There are many people who ignore the difference between rehydration components when rehydrating. The importance of properly proportioning rehydration components has been made clear through the above explanation, and ignoring the difference between rehydration components is unwarranted and dangerous.
- The calculation of the postoperative rehydration volume has nothing to do with the intraoperative rehydration volume of the anesthesiologist.
An organic whole cannot be separated between the fluids you infuse and the fluids infused by others. In clinical work, it is true that some problems caused by improper rehydration by anesthesiologists and not corrected by clinicians in Time can be encountered.
This problem should attract the full attention of orthopedic surgeons, after all, the professional level of each professional varies is objective, do not others planted the bitter fruit you to pick.
- Inadequate rehydration or fluid imbalance mostly shows neurological or circulatory symptoms, orthopedic surgeons “treat the foot and headache”, or to “avoid” responsibility, they simply ask for internal medicine consultation.
Think about it, the perioperative rehydration of orthopedic patients should be better informed by our professionals, and we ignore the problems expecting internal medicine physicians to supplement and discover them for you, which is a risky behavior, and some conditions are often delayed in the constant consultation.
This situation must be brought to the attention of the young orthopedic surgeon, knowing that the Family will certainly not go to claim the internist when something goes wrong.
As long as you manage on the patient, remember that he is always your responsibility before discharge, you can not put the blame on other departments of doctors, even if he handled the error, it is difficult to define, and then again, the internal medicine doctor is generally in the identity and role of a helper.
- When rehydrating fluids, physicians do not order their orders and nurses do not execute them sequentially.
There are differences in the composition of rehydration fluids, and the organism’s demand for various components has priorities, so the order of sequential input should be different, for example, if you infuse sugar first for hypotonic dehydration, the condition is bound to worsen. Therefore, the sequence of rehydration must be taken seriously. Doctors should not only strictly design the sequence of various fluid input, but also should closely communicate and supervise with nursing staff.
Some physicians are overly concerned about the cardiac function of the elderly and think that they should not rehydrate more, but less is better.
The buffering capacity of the elderly body is weak, so if the rehydration is insufficient or inappropriate, problems are more likely to occur, such as insufficient volume can lead to slow blood flow, and the elderly are prone to embolism; insufficient volume or hydropower imbalance is also prone to heart problems, because the heart function of the elderly is reduced.
Putting anyone in an abnormal internal environment is definitely detrimental. Of course, we must consider the contradiction between rehydration and low cardiac function in the elderly. We firstly emphasize that the amount of rehydration should be more precise rather than less; secondly, the speed of infusion should be slowed down appropriately, and thirdly, early feeding and oral electrolyte solution should be taken.
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