NMS. Casos Clínicos

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Part I ♦ Foundations incision of the respiratory tract mucosa. For invasive respiratory tract procedures to treat an established infection (e.g., drainage of abscess, empyema), administer an antibiotic that is active against Streptococcus viridans . Patients with high cardiac risk who undergo a surgical procedure that involves infected skin, skin structure, or musculoskeletal tissue should receive an agent active against staphy- lococci and beta-hemolytic streptococci (e.g., antistaphylococcal penicillin, cephalosporin). If the causative organism of respiratory, skin, skin structure, or musculoskeletal infec- tion is known or suspected to be Staphylococcus aureus , administer an antistaphylococcal penicillin or cephalosporin, or vancomycin (if patient is unable to tolerate beta-lactam anti- biotics). Vancomycin is recommended for known or suspected methicillin-resistant strains of S. aureus . Antibiotics are no longer recommended for endocarditis prophylaxis for patients un- dergoing genitourinary or GI tract procedures. Case 1.11 Surgery in a Patient with Cardiomyopathy You are asked to see a patient with colon cancer who needs a left colectomy. There is a known cardiomyopathy, with mild shortness of breath and fine rales in both lung bases. Q: How would you manage the patient perioperatively? A: Patients with cardiomyopathy are at risk for complications such as arrhyth- mias, CHF, cardiac outflow obstruction, and sudden death. Because this patient needs elective surgery, there should be a careful evaluation by a cardiologist. Patients who require urgent surgery should have their fluid status carefully controlled and possible arrhythmias monitored. Pulmonary artery catheterization and/or transesophageal echo- cardiography may be necessary to manage volume status properly.

CUT TO TEXTBOOK For more information, see NMS Surgery , 7th ed, Chapter 2, Preoperative Considerations. SAMPLE