4- General Surgery Flashcards
When should tobacco be discontinued prior to surgery?
8 weeks
What meds should be continued in the perioperative period? (3)
Meds w/ significant withdrawal sxs not affecting anesthesia
CV meds
Statins
When should antiplatelet meds be d/c prior to surgery?
7-10 days prior
In low and mod risk patients, how does risk for operative mortality change for emergent procedures?
Doubles
What is the greatest RF/ predictor of DVT/ PE or bleeding risk?
Prior history
What nutrition state results in increased risk for surgical complications?
Severe malnutrition
Weight loss > 15% over prior 3-4 months
When is the body using carbohydrate vs fat stores?
Carbohydrate stores @ 24-72 hours
Fat stores @ 72hrs- 10 days (adaptive changes)
What is the nutritional status of a surgical pt hours after injury when pt exhibits sxs of shock and NE release?
Ebb phase
What is the nutritional status of a surgical pt days after injury when pt exhibits catabolic > anabolic processes (hypermetabolic, hyperglycemic, increased CO)?
Flow phase (peaks 3-5 days)
What is the nutritional status of a surgical pt weeks after injury when pt exhibits anabolic processes such as corticoid withdrawal and repletion?
Recovery phase
What lab test is used to indicate stress on the body if a pt has been in the hospital for a long time and has a half life of 21 days?
Serum albumin
< 3.5 g/dL
What lab test is used to indicate stress on the body, is highly sensitive, has a half life of 2-3 days and is used for trending purposes?
Prealbumin
< 5-17 g/dL
What lab test is used to indicate stress on the body by indicating if a pt is protein deficient and has a half life of 8 days?
Serum transferrin
< 200 mg/dL
What is the preferred nutrional support used for malnourished pts?
Enteral > parenteral
“if the gut works use it”
What is the nutritional caloric need for a “stressed” pt?
Stressed: 50 kcal/kgday, 2.5 protein/kg/day
What body temp should be maintained during immediate post op period for prevention of complications?
Core temp between 98.6- 100.4
What levels should glucose be maintained at through the surgical procedure?
150 mg/dL
When should hair removal be performed (clippers) for surgery?
Immediately prior to prep of surgical field
What skin antiseptics are preferred for prevention of surgical complications?
Chlorhexidine solutions (applied and air dry)
What oxygenation levels should be maintained intraoperatively?
80%
What is the most common method for prevention of VTE?
Mechanical (pneumatic compression)
+/- systemic anticoagulant
When should fluids and electrolytes be evaluated for POD 1 vs POD 2/ beyond?
POD 1- q 4-6 hrs
POD 2/ beyond- q 24 hrs
What is the preferred replacement IVF?
Crystalloids > colloids/ blood products
(colloids/ blood products more likely to stay in vascular compartment, colloids not used for rehydration/ bolus unless large amts of fluid loss)
What is the most common crystalloid used in the peri-operative period?
Isotonic > hyper/ hypotonic