ABSITE Flashcards
Small Bowel Stricturoplasty
In the small bowel, a single short-segment (5-7 cm) stricture should be treated with Heinecke-Mikulicz stricturoplasty, a medium-segment (10-15 cm) stricture with Finney stricturoplasty, and a long-segment (> 15 cm) stricture with Michelassi stricturoplasty.
Septic Shock
low central venous pressure (CVP), low pulmonary capillary wedge pressure (PCWP), high cardiac index (CI), and low systemic vascular resistance (SVR)
Hypovolemia/Hemorrhage
low CVP, low PCWP, low CI, and high SVR
Cardiogenic Shock
high CVP, high PCWP, low CI, and high SVR
Cormack-Lehane Grades
In grade 1, there is a full view of the glottis. In grade 2, there is a partial view of the glottis. In grade 3, only the epiglottis and none of the glottis is seen. In grade 4, neither the glottis nor the epiglottis is seen.
MC primary malignant peritoneal neoplasm
Malignant mesothelioma is the most common primary malignant peritoneal neoplasm
Gastric Emptying
A gastric emptying study is considered abnormal if more than 60% of the radiotracer is present in the stomach at 2 hours or if more than 10% of the radiotracer is present in the stomach at 4 hours
SIRS
SIRS is initiated by either DAMPs, which are released by damaged or dying host tissues, or by pathogen-associated molecular patterns (PAMPs), which are expressed on foreign pathogens such as bacteria. SIRS is mediated by several types of immune cells, including neutrophils, monocytes, macrophages, and dendritic cells. SIRS is mediated by both the innate and adaptive immune systems. SIRS can occur after infection, severe trauma, or major surgery.
Macrophages
Macrophages are required for wound healing and are primarily responsible for the secretion of chemotactic agents and growth factors (proliferation and angiogenesis) necessary for wound healing.
Intestinal perfusion
The pancreaticoduodenal artery provides a vital collateral pathway between the celiac artery and the superior mesenteric artery.
Ostomy output
High ileostomy output is defined as greater than 1200 mL/d. Without controlling high output unlikely to be able to maintain electrolytes and volume status. Loperamide is an appropriate next step in management
Malignant hyperthermia
Malignant hyperthermia is a rare life-threatening reaction to potent volatile anesthetics (“fluranes”) and succinylcholine. It causes unregulated oxidative metabolism in skeletal muscle, leading to increased body temperature, acidosis, increased CO2 production, and rhabdomyolysis. If malignant hyperthermia is suspected, all possible triggering agents must be stopped. Patients with malignant hyperthermia or suspected malignant hyperthermia need emergent treatment with dantrolene, active cooling, and ongoing supportive care in a critical care setting to support organ function
Rectal prolapse
A diagnostic evaluation with endoscopy is required before surgical intervention for rectal prolapse. CT is typically not indicated in the workup for rectal prolapse. MRI defecography may be useful to evaluate the pelvic floor musculature but is not required in all cases.
Leiomyomas
The location and size of the tumor are important factors in determining the appropriate surgical approach. Endoscopic approaches are preferred for tumors less than 5 cm in size. Tumors larger than 5 cm should be excised by video-assisted thoracoscopic surgery or laparoscopy depending on the location. posterior mediastinal lymph nodes distally, ultimately to the thoracic duct
The Parkland formula for Burn Patients
The Parkland formula is 4 mL/kg per percent total body surface area burned, to be given over the first 24 hours. Half should be given in the first 8 hours, and the other half should be given in the next 16 hours.
Fragilty
The five elements of phenotypic frailty are unintentional weight loss, weak grip strength, self-reported exhaustion, slow walking speed, and low physical activity
Synchronized cardioversion
Synchronized cardioversion is timed (synchronized) with the QRS complex. This avoids shock delivery during the relative refractory portion of the cardiac cycle, when a shock could produce ventricular fibrillation. Synchronized cardioversion is recommended to treat supraventricular tachycardia, atrial fibrillation, atrial flutter, atrial tachycardia, and monomorphic VT with pulses. Synchronized cardioversion must not be used for treatment of VF, as the device may not sense a QRS wave and thus a shock may not be delivered.
Defibrillation
Ventricular fibrillation and ventricular tachycardia require defibrillation. Any other rhythms without pulse (atrial fibrillation, supraventricular tachycardia) would fall under the category of pulseless electrical activity and do not necessitate defibrillation.
Nondepolarizing agents
Neuromuscular blockade by nondepolarizing agents, including rocuronium, vecuronium, and atricurium, can be “reversed.” For rocuronium, a chelating agent, sugammadex, is available. In general, for these agents, a cholinesterase inhibitor such as neostigmine can be given to increase the amount of acetylcholine in the synapse and displace the competitive antagonists that mediate neuromuscular blockade
