Avoiding Common Surgical Errors

, by Marcucci, Lisa; Moritz, Michael J.; Chen, Herbert

Note: Supplemental materials are not guaranteed with Rental or Used book purchases.

ISBN: 9780781747424 | 0781747422
Cover: Paperback
Copyright: 10/5/2005

Sorry, this item is currently not available.

This pocket book lists 186 errors commonly made by attendings, residents, interns, nurse practitioners, and physician assistants when working with surgical patients on the ward or in the operating room, emergency room, or intensive care unit. The book can easily be read immediately before the start of a rotation or used for quick reference on call. Each entry includes an explanation of the clinical scenario in which the error can occur and the relevant anatomy and pathophysiology. Illustrations of pertinent anatomy, instruments, and devices are included.

PREFACE

vii

CONTRIBUTORS

EMERGENCY DEPARTMENT

1 Remember the classic triad for a ruptured abdominal aortic aneurysm—hypotension, pulsatile abdominal mass, and severe abdominal/back pain

Lisa Marcucci, MD

(4)

2 Look for a ruptured aneurysm or aortic dissection in any patient who complaints of flank pain

Harsh Jain, MD

(3)

3 Consider aortic injury or thoracic great vessel injury if a patient has fractures of the first or second ribs

Ahmed G. Mami, MD

(2)

4 Evaluate the patient for mediastinal or heart injuries if a sternal fracture is present

Adrian Lata, MD

(4)

5 Have a high index of suspicion for nerve injures in humeral fractures and dislocations

Ahmed G. Mami, MD

(3)

6 Give prophylactic antibiotics on initial evaluation of an open fracture

Lisa Marcucci, MD

(2)

7 Have a high index of suspicion for compartment syndrome after tibial fractures

Lisa Marcucci, MD

(2)

8 Line up the vermilion border when repairing a lip laceration

Nadine Semer, MD

(2)

9 Do not shave the eyebrow when repairing a laceration to this area

Nadine Semer, MD

(2)

10 Use absorbable sutures when repairing a laceration on a young child

Nadine Semer, MD

(1)

11 Do not use staples when repairing a facial laceration

Nadine Semer, MD

(1)

12 Admit a knee dislocation for observation if an arteriogram is not performed to rule out popliteal artery injury

Michael J. Moritz, MD

(2)

13 Do not incise and drain an abscess in the antecubital fossa, groin, or neck in the emergency room

Mark S. Sneider, MD

(2)

14 Treat a perirectal abscess in a diabetic as a surgical emergency

Michael J. Moritz, MD

(3)

15 Make a wide incision when draining an abscess

Nadine Semer, MD

(2)

16 Do not close a human bite on the hand

Michael J. Moritz, MD

(2)

17 Do not discard a traumatically amputated body part (finger, ear, lip) until a plastic surgeon has evaluated it for possible replantation

Nadine Semer, MD

(2)

18 Do not allow a traumatically amputated tissue segment to become immersed unprotected in ice/cold saline

Nadine Semer, MD

(1)

19 Counsel the patient to stop smoking when treating a hand injury, soft tissue injury, or fracture

Nadine Semer, MD

(1)

20 Elevate an injured or infected hand

Nadine Semer, MD

(1)

21 Admit a patient with second degree burns to the dorsum of the foot

Nadine Semer, MD

(2)

22 Strongly consider electively intubating a patient who has suffered inhalation burn injuries or significant burn injuries to the face or mouth

Michael J. Moritz, MD

(2)

23 Make sure tetanus prophylaxis is up-to-date with stab and gunshot wounds, burns, frostbite, corneal injury with metallic implants, and bite wounds

James Kirkpatrick, MD

(2)

24 Do not debride tissue on initial evaluation in a patient with a frostbite injury unless there are signs of surrounding infection

Nadine Semer, MD

(2)

25 Cover eyelid lacerations promptly with a damp dressing while waiting for ophthalmology or plastics to evaluate the patient

Michael J. Moritz, MD

(3)

26 Be alert for duct and facial nerve injury in facial and cheek lacerations

Justin Young, MD

(3)

27 Remember to account for all missing teeth after maxillofacial trauma

Justin Young, MD

(2)

28 Completely undress a patient when examining them for traumatic injury

Michael J. Moritz, MD

(2)

29 Do not nasotracheally intubate or place a nasogastric tube in a patient who has or may have facial or skull fractures

Michael J. Moritz, MD

(2)

30 Do not blame hypotension on an intracranial injury in a trauma setting unless all other causes have been ruled out

X.D. Dong, MD

(2)

31 Obtain a chest radiograph, pelvic radiograph, and lateral, anterior-posterior, and open mouth cerivical-spine films (or the computed tomography equivalents) in blunt trauma or a fall

Michael J. Moritz, MD

(3)

32 Do not clear a neck based on lack of tenderness if patient has distracting pain or is intoxicated

Richard Pucci, MD

(3)

33 Obtain lumbar spine radiographs in patients with a positive seat belt sign

Lisa Marcucci, MD

(2)

34 Do a rectal exam before inserting a urinary catheter in male trauma

Michael J. Moritz, MD

(3)

35 Do not rule out intra-abdominal trauma by clinical exam if the patient is intoxicated or has altered sensorium

Michael Silber, DO

(1)

36 Be aware that it is possible to bleed to death from a scalp wound

X.D. Dong, MD

(2)

37 Close the galea as a separate layer when repairing a full-thickness laceration to the scalp

Nadine Semer, MD

(2)

38 Do not remove a knife that is penetrating tissue unless you have a direct intraoperative vision and control

James Herrington, MD

(1)

39 Explore an expanding retroperitoneal hematoma caused by trauma should be explored

X.D. Dong, MD

(3)

40 Do not give disulfiram (antabuse) or metronidazole (Flagyl) to a patient who has alcohol in his or her system

Michael J. Moritz, MD

(2)

41 Have an extremely low threshold for mechanical control of the airway in Ludwig's angina

Lisa Marcucci, MD

(2)

42 Treat myoglobinuria with copious intravenous saline fluid

Rachael A. Callcut, MD

(2)

43 Consider and exclude the highly lethal diagnosis of midgut volvulus in an infant with bilious vomiting

Michael J. Moritz, MD

(2)

44 Consider the possibility of an underlying malignancy when treating a woman with breast inflammation or abscess

Michael J. Moritz, MD

(4)

45 Wear gloves when examining a patient in the emergency room

Michael J. Moritz, MD

(3)

46 Promptly dispose of your own sharps after doing a bedside or emergency room procedure

Michael J. Moritz, MD

100

(2)

OPERATING ROOM

47 Institute deep vein thrombosis prophylaxis before the induction of anesthesia

Diane L. Ferrara, RN, PA and Michael J. Moritz; MD

102

(5)

48 Do not use chlorhexidine to prep the face (to avoid corneal and middle ear injury)

Sue-Mi Cha, MD

107

(2)

49 Prep and drape both legs to the midfoot when doing vascular procedure on an extremity

Michael, Moritz, MD

109

(2)

50 Use meticulous attention to correct positioning when placing a patient in the lateral decubitus position

Ashraf Osman, MD

111

(3)

51 Do not inject any substance into a patient in the operating room without first informing the anesthesiologist

Catherine Marcucci, MD

114

(2)

52 Do not move an intubated patient (especially the patient's head and neck) without first obtaining permission from the anesthesia staff

Catherine Marcucci, MD

116

(1)

53 Repair a common bile duct injury as close to the hilar plate as possible

Adrian Lata, MD

117

(2)

54 Remember the Pringle Maneuver (the use of which in hepatic trauma is less successful than generally thought) will not control a replaced or accessory left hepatic artery or control hepatic venous bleeding

Michael J. Moritz, MD

119

(3)

55 Do not allow a patient to bleed to death from a liver injury

Michael J. Moritz, MD

122

(3)

56 Have a low threshold for converting a laparoscopic cholecystectomy to an open cholecystectomy

Michael B. Silber, DO

125

(3)

57 Know the three places where small bowel antimesenteric fat is found when "lost" among loops of bowel

Michael J. Moritz, MD

128

(2)

58 Free up the bowel proximally and distally when repairing an enterotomy to avoid fistula formation

X.D. Dong, MD

130

(2)

59 Make sure that the red rubber catheter in a Witzel jejunostomy is going distally in the small bowel lumen

Michael J. Moritz, MD

132

(3)

60 Avoid undue traction on the left renal vein when exposing the neck of an aortic aneurysm

Michael j. Moritz, MD

135

(3)

61 Remember that inferior polar arteries to the right kidney cross the infrarenal inferior vena cava

James Herrington, MD

138

(2)

62 Use clips for hemostasis sparingly and with care in proximity to where vascular clamps might be used

Michael J. Moritz, MD

140

(2)

63 Check the jaws of a vascular clamp before applying

James Herrington, MD

142

(3)

64 Obtain proximal and distal control before exploring a vascular wound

Michael J. Moritz, MD

145

(2)

65 Do not use a permanently non-absorbable suture on the bladder or ureter

Michael J. Moritz, MD

147

(2)

66 Never think you know where the bladder is—it can look a lot like the colon

Michael J. Moritz, MD

149

(2)

67 Avoid initially grabbing the appendix or tip of appendix when doing a laparoscopic appendectomy

Michael J. Moritz, MD

151

(2)

68 Do not initially close the skin completely after doing fasciotomy for compartment syndrome

James Herrington, MD

153

(3)

69 Use blunt dissection when doing an emergency venous cutdown

Michael J. Moritz, MD

156

(3)

70 Make sure that breast biopsy sites are bone dry before closing

Michael J. Moritz, MD

159

(2)

71 Place the marking stitches to orient specimen before excising a lesion that might be malignant

Michael J. Moritz, MD

161

(2)

72 Do not do a shave biopsy on a lesion suspicious for melanoma

X.D. Dong, MD

163

(5)

73 Handle sutures with proper technique to decrease fascial dehiscence

Ramon Rivera, MD

168

(2)

74 Do not reach onto the scrub nurse's table without permission

Michael J. Moritz, MD

170

(1)

75 Do not call the anesthesiologists or nurse anesthetists "anesthesia" or "Dr. Anesthesia"

Catherine Marcucci, MD

171

(1)

MEDICATIONS

76 Make sure that intravascular medications are not inadvertently placed in the extravascular space and extravascular medications are not placed intravascularly

Michael J. Moritz, MD

172

(5)

77 Do not give a verbal order for a medication without inquiring about the patient's allergies

Rachael A. Callcut, MD

177

(2)

78 Do not prescribe a Kayexalate-sorbitol enema to a kidney transplant patient

Dmitriy Nikitin, MD

179

(2)

79 Remember to change the dosage when converting from the intravenous (IV) to the oral (PO) form of immunosuppressive and other drugs in transplant patients

Dmitriy Nikitin, MD

181

(3)

80 Do not allow St. John's wort to be co-administered with cyclosporine, tacrolimus, or sirolimus

Neil Sandson, MD

184

(2)

81 Do not prescribe a non steroidal anti-inflammatory drug (NSAID) or an aminoglycoside to a patient with cirrhosis

Michael J. Moritz, MD

186

(2)

82 Be cautious when using Demerol in patients with renal insufficiency

Michael J. Moritz, MD

188

(1)

83 Remember that antibiotics can have severe and irreversible side effects with even short courses

Michael J. Moritz, MD

189

(3)

84 Consider prescribing Lactobacillus (or other probiotic therapy) when a patient receives any dose of antibiotics

Lisa Marcucci, MD

192

(3)

85 Check peak and trough levels when dosing aminoglycosides and trough levels in select situations when dosing vancomycin

Harsh Jain, MD

195

(4)

86 Avoid long courses of antibiotics with significant anti anaerobic activity to lessen the risk of vancomycin resistant enterococcus

Michael J. Moritz, MD

199

(3)

87 Do not prescribe intravenous vancomycin to treat Clostridium difficile

Michael J. Moritz, MD

202

(2)

88 Consider double-covering Pseudomonas infections

Michael J. Moritz, MD

204

(3)

89 Remember to give vaccines for Haemophilus inflnenzae, Meningiococcus and Pneumococcus in patients who undergo a splenectomy, and always have a high index of suspicion for overwhelming postsplenectomy sepsis (OPSS) in patients with splenectomy

Harsh Jain, MD

207

(3)

90 Consider the use of fluconazole prophylaxis in intensive care patients with severe pancreatitis, abdominal sepsis, or need for multiple abdominal surgeries

Lisa Marcucci, MD

210

(2)

91 Do not prescribe Viagra to a patient taking nitrates and vice versa

Ashraf Osman, MD

212

(2)

92 Do not prescribe hydrocodone (Vicodin, Lortab) or tramadol (Ultram) to a patient who is taking fluoxetine (Prozac), paroxetine (Paxil), or high-dose sertraline (Zoloft)

Neil Sandson, MD

214

(1)

93 Do not prescribe monoamine oxidase inhibitors (MAOIs) to a patient who is taking a selective serotonin reuptake inhibitor (SSRI)

Neil Sandson, MD

215

(1)

94 Give prophylactic perioperative beta-blockers for patients at risk for cardiac ischemia

Michael J. Moritz, MD

216

(3)

95 Consider N-Acetylcysteine or sodium bicoarbonate prophylaxis along with adequate hydration to combat contrast-induced nephropathy

Michael J. Moritz, MD

219

(2)

96 Do not use "renal dose" dopamine

Lisa Marcucci, MD

221

(2)

97 Stop met formin (Glucophage) before any elective surgery (however minor) or intravascular contrast study to avoid lactic acidosis

Michael J. Moritz, MD

223

(2)

98 Make sure the heparin is removed from the intravenous flushes and heparin-coated lines are removed if a patient is diagnosed with heparin-induced thrombocytopenia

Heather Abernethy, MD

225

(2)

99 Have a high threshold for administering Vitamin K intravenously

Michael J. Moritz, MD

227

(2)

100 Do not push intravenous verapamil without the patient being monitored for cardiac rhythm and blood pressure

Richard Pucci, DO

229

(2)

101 Be cautious when loading a patient with intravenous Dilantin

Ahmed G. Mami, MD

231

(2)

102 Monitor the patient when using protamine to reverse heparin

Heather Abernethy, MD

233

(2)

103 Check for history of migraine before giving Zofran

Michael J. Moritz, MD

235

(2)

104 Become familiar with the antidotes to commonly prescribed drugs

Michael J. Moritz, MD

237

(6)

105 Consider drugs as a possible cause of leukocystosis

Lisa Marcucci, MD

243

(3)

LINES, DRAINS, AND TUBES

106 Do not draw blood proximal to an intravenous line that is infusing

Gregory Kennedy, MD, PhD

246

(3)

107 Go above the rib when placing a chest tube or needle into the chest cavity

Heather Abernethy, MD

249

(2)

108 Do not push a malpositioned chest tube into the thoracic cavity

Michael J. Moritz, MD

251

(2)

109 Do not allow a patient to vomit around a nasogastric tube

Lisa Marcucci, MD

253

(2)

110 Confirm correct placement of a Foley catheter by return of urine

Lisa Marcucci, MD

255

(2)

111 Be reluctant to allow more then 500 mL to drain out of a newly placed catheter or drain at one time

Lisa Marcucci, MD and Kenneth Meredith, MD

257

(2)

112 Obtain a drain study when the output from a drain in an abscess cavity decreases abruptly

Kenneth Meredith, MD and Lisa Marcucci, MD

259

(1)

113 Release the suction on the bulb before removing a Jackson-Pratt drain

Lisa Marcucci, MD and Kenneth Meredith, MD

260

(2)

114 Use a dedicated, upper body, single lumen central venous catheter for administration of parenteral nutrition

Lisa Marcucci, MD

262

(2)

115 Be meticulous in technique when inserting and caring for central venous access catheters in the intensive care unit to lower the incidence of infection

Lisa Marcucci, MD

264

(2)

116 Avoid the subclavian vein for central access of any type in a dialysis patient or possible dialysis patient

Michael J. Moritz, MD

266

(3)

117 Do not enter the femoral artery or vein superior to the inguinal ligament when attempting a needle cannulation

Lisa Marcucci, MD and Kenneth Meredith, MD

269

(2)

118 In a patient with a previously placed vena cava filter, do not use the J-tip on the guidewire when using the Seldinger technique to place a central venous catheter

Lisa Marcucci, MD

271

(2)

119 Aim for the ipsilateral nipple when placing a central venous catheter in the internal jugular vein

Heather Abernethy, MD

273

(2)

120 Advance the needle into the vein with the plunger pulled back gently when doing central venous access

Lisa Marcucci, MD

275

(2)

121 Maintain control of the wire when putting in a central line using the Seldinger technique

Lisa Marcucci, MD

277

(2)

122 Check for venous blood before dilating the tract when inserting a central venous catheter

Michael J. Moritz, MD

279

(3)

123 Do not push the dilator in the entire length when using the Seldinger technique to insert a central venous catheter

Lisa Marcucci, MD and Kenneth Meredith, MD

282

(2)

124 Secure a central line with anchoring sutures at four sites

Lisa Marcucci, MD

284

(2)

125 Do not insert, remove, or change a central line in the upper torso unless the patient is lying flat or is in the Trendelenberg position

Michael J. Moritz, MD

286

(2)

126 Obtain a chest radiograph before switching sides when attempting elective subclavian or jugular central line placement

Lisa Marcucci, MD

288

(2)

127 Check for left bundle-branch block on an electrocardiogram before placing a pulmonary artery catheter

Michael J. Moritz, MD

290

(3)

128 Be extremely cautious when manipulating the balloon used in pulmonary artery catheters

Lisa Marcucci, MD

293

(5)

WOUNDS

129 Remember that the first symptom of a wound infection is pain, and the first sign is tenderness (not erythema)

Heather Abernethy, MD

298

(4)

130 Consider the VAC dressing for difficult wounds

Michael J. Moritz, MD

302

(2)

131 Examine the wound when a patient has a high fever, especially within 12 to 24 hours of surgery

Rachael A. Callcut, MD

304

(1)

132 Do not debride a dry/black eschar overlying a decubitus ulcer in a bedridden patient who has no evidence of underlying cellulitis

Nadine Semer, MD

305

(1)

133 Strongly consider the diagnosis of fascial dehiscence when a wound drains pinkish or salmon-colored fluid

Michael J. Moritz, MD

306

(4)

BLEEDING

134 Look for the source of a lower gastrointestinal bleed in the upper gastrointestinal tract

Rachael A. Callcut, MD

310

(3)

135 Remember that bleeding in the right upper quadrant diagnosed by a bleeding scan can be from the hepatic flexure of the colon or the duodenum

Michael J. Moritz, MD

313

(2)

136 Recognize herald bleeding and institute the appropriate diagnostic and therapeutic maneuvers

Michael J. Moritz, MD

315

(3)

137 Discuss when and how to reanticoagulate a patient postoperatively with a senior member of the surgical team

Michael J. Moritz, MD

318

(2)

138 Consider a retroperitoneal bleed if a patient has new onset flank pain, ecchymosis, or back pain

Michael J. Moritz, MD

320

(2)

139 Do not presume that a gastrointestinal bleed in a patient with known cirrhosis is from varices

Michael J. Moritz, MD

322

(3)

140 Have a high index of suspicion for liver injury in children who receive chest compressions

Mark S. Sneider, MD

325

(3)

GASTROINTESTINAL TRACT

141 Mediastinitis from an esophageal perforation is a treatment emergency

Michael J. Moritz, MD

328

(4)

142 During rectal examination, initially insert the fingertip just slightly and hold for several seconds

Rachael A. Callcut, MD

332

(1)

143 Perform routine rectal exams

Rachael A. Callcut, MD

333

(2)

144 Do not believe the old surgical dictum that it is not possible to reduce a hernia if it contains dead bowel

Michael J. Moritz, MD

335

(3)

145 Do not use high-density barium for an initial contrast study when a gastrointestinal (GI) perforation or leak is suspected

Michael J. Moritz, MD

338

(1)

146 Be cautious when evaluating the abdomen of a patient taking corticosteroids

Ramon Rivera, MD

339

(2)

147 Do not allow a "negative CT" (computed tomography) to prevent you from taking a case of suspected appendicitis to the operating room if the diagnosis is supported clinically

Lisa Marcucci, MD

341

(2)

148 Have a high index of suspicion for ischemic colitis if a patient has a bowel movement in the first 24 hours post operatively after an abdominal aortic repair

Michael J. Moritz, MD

343

(2)

149 Do not do perform elective hernia repairs or hemorrhoidectomies in patients who have cirrhosis

Michael J. Moritz, MD

345

(2)

150 Consider gastric dilatation when a patient is having respiratory difficulty

Rachael A. Callcut, MD

347

(2)

151 Have a high index of suspicion for incarcerated or strangulated hernia if a patient has a bowel obstruction and no previous abdominal surgery

James Herrington, MD

349

(5)

152 Consider an anastomotic leak, inadvertent enterotomy, or devitalized loop of bowel if tachycardia and/or tachypnea that is resistant to fluids occurs after abdominal surgery

Michael J. Moritz, MD

354

(4)

WARDS

153 Consider consulting psychiatry on admission of the patient to evaluate for competency

Neil Sandson, MD

358

(4)

154 Do not discharge a patient if he or she wishes to leave the hospital against medical advice

Michael J. Moritz, MD

362

(2)

155 Investigate cardiac devices (pacemakers) before taking the patient to the operating room

Catherine Marcucci, MD

364

(2)

156 Include the order "No procedures on arm (the side operated on)" when writing postoperative orders for modified radical mastectomy and lumpectomy and axillary lymph node dissection

Harsh Jain, MD

366

(2)

157 Order an ampule of naloxone (Narcan) to the bedside when writing orders for patient-controlled analgesia or if the patient is receiving continuous epidural narcotic infusion

Catherine Marcucci, MD

368

(2)

158 Use 20 seconds of acupressure with your fingertip to decrease patient discomfort at the insertion site of a needle

Rachael A. Callcut, MD

370

(1)

159 Do not attempt a radial and ulnar artery cannulation on the same side at the same sitting

Heather Abernethy, MD

371

(3)

160 Make the decision to intubate based on the overall clinical picture

Jack Hudkins, MD

374

(2)

161 Do not attempt to elucidate ischemic changes on an electrocardiogram that has a left bundle-branch block

Lisa Marcucci, MD

376

(2)

162 Treat crepitus associated with a soft tissue infection with a high level of concern that may require definitive treatment in the operating room

James Herrington, MD

378

(3)

163 Do not administer sterile water intravenously to correct hypernatremia

Lisa Marcucci, MD

381

(2)

164 Consider physical restraints on combative hepatic encephalopathy patients

Michael J. Moritz, MD

383

(3)

165 Diabetics often do not have chest pain in myocardial infarction and absence of angina can not be used to rule out signficant coronary artery disease

Rachael A. Callcut, MD

386

(2)

166 Remember when reviewing Doppler ultrasound results that the superficial femoral vein is a component of the deep enous system

Patrick Schaner, MD

388

(2)

167 Aggressively treat phlebitis from intravenous sites in immunosuppressed or heart valve patients

Gregory Kennedy, MD

390

(2)

168 Assume that if a patient is not doing well post-operatively, there is an undiagnosed complication of your procedure until proven otherwise

Rachael A. Callcut, MD

392

(2)

169 Examine the patient before switching pain medication when a patient complains of a lack of relief

Rachael A. Callcut, MD

394

(1)

170 Do not discount a patient's complaint of neck or back pain

Michael J. Moritz, MD

395

(3)

171 Be alert for abdominal sepsis in the morbidly obese patient

Adrian Lata, MD

398

(3)

172 Consider an Addisonian state if it "looks like sepsis and smells like sepsis" but you cannot identify any offending microbes

Rachael A. Callcut, MD

401

(2)

173 Do not put adhesive tape on a patient with fragile skin

Michael J. Moritz, MD

403

(2)

174 Do a thorough head and neck examination when an anterior neck mass is discovered, and do a fine-needle aspiration of the mass as the first tissue diagnosis procedure

Michael J. Moritz, MD

405

(2)

175 Stay up-to-date on the latest advanced cardiac life support (ACLS) protocols

Lisa Marcucci, MD

407

(1)

176 Always ask for help if you are uncertain of the best course of action

Michael J. Moritz, MD

408

(2)

INTENSIVE CARE UNIT

177 Do not attempt to wean a patient on a ventilator with an abdominal binder in place

Lisa Marcucci, MD

410

(4)

178 Strongly consider the use of smaller tidal volumes when ventilating patients with acute lung injury or acute respiratory distress syndrome

Lisa Marcucci, MD

414

(1)

179 Allow a sedated patient to awaken every 24 hours

Michael J. Moritz, MD

415

(2)

180 Maintain tight glucose control in the intensive care unit

Michael J. Moritz, MD

417

(3)

LABORATORY

181 Obtain a pregnancy test on every female between the ages of ten and fifty years

Gregory Kennedy, MD

420

(4)

182 Do not use a Hemoccult test kit to test for the presence of blood in gastric contents

Rachael A. Callcut, MD

424

(1)

183 Do not disregard an even slightly elevated partial thromboplastin time (PTT) when the prothrombin time (PT) is normal

Lisa Marcucci, MD

425

(3)

184 Remember that urine electrolytes, commonly used as an indicator of intravascular volume, are significantly altered after diuretics are given

Michael J. Moritz, MD

428

(3)

185 Make sure that the labs drawn for tacrolimus and cyclosporin levels are timed appropriately

Michael J. Moritz, MD

431

(2)

186 Know the risks of disease transmission and the universal donor and recipient types for transfusion (the universal donor for red cells is "O" negative and for fresh frozen plasma (FFP) is "AB" positive)

Michael J. Moritz, MD

433

(4)

INDEX

437

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Avoiding Common Surgical Errors

Summary

Table of Contents

Supplemental Materials