Antibiotics

Question 1

What surgical techniques can we use to prevent SSI (surgical site infection)? (7)

Answer 1

Gentle traction
Effective hemostasis
Removal of devitalized tissues
Obliteration of deadspace
Irrigation with saline
Fine non-absorbed suture
Closed suction drains
Wound closure without tension

Question 2

What are patient medical conditions that would affect healing and increase risk of infection? (7)

Answer 2

Extremes of age
Malnourished
Obesity
Diabetes
Recent operation
Corticosteroid therapy
Immunocompromised

Question 3

What are perioperative factors that would affect post-surgical healing? (6)

Answer 3

Body Temperature
FiO2
Fluid Management
Blood Glucose
Blood transfusion
Antimicrobial Prophylaxis

Question 4

Pts that are cold are at reduced risk for infection. True or false?

Answer 4

False, is at increased risk because when pt is cold, there is vasoconstriction, ie. less blood flow to encourage healing.

Question 5

What are the benefits of normothermia? (2)

Answer 5

Better wound healing

Less vasoconstriction

Question 6

When pt is hypothermic, what are the causes of SSI? (4)

Answer 6

Decreased tissue perfusion
Decreased super oxide radicals
Induced anti-inflammatory profile
Decreased collagen production

Question 7

How can we prevent hypothermia? (3)

Answer 7

Forced air warming
Warmed fluids
Warm the room

Question 8

We realize a decrease of SSI with FiO2 = _____.

Answer 8

0.8

Note: Not feasible post operatively.

Question 9

Sometimes sub-cutaneous tissue is hypovolemic when the pt seems to be euvolemic. True or false?

Question 10

Is there a significant change in rate of SSI when colloid vs. crystalloid is used?

Answer 10

No.

Question 11

What is the goal when dealing with pt’s fluid management?

Answer 11

Euvolemia to maintain perfusion.

Question 12

What are the adverse effects of hyperglycemia? (4)

Answer 12

Increased morbidity/mortality
Decreased leukocyte count
Deactivation of immunoglobulins
Functional deficits of neutrophils

Question 13

We strictly monitor blood glucose because: (2)

Answer 13

Reduce multi-organ failure with sepsis
Reduce rate of SSI

Question 14

Risk of SSI is decreased with autologous PRBC via cell saver. True or false?

Answer 14

True

Question 15

What are the goals of surgical prophylaxis? (6)

Answer 15

Prevent postoperative SSI
Prevent post-op M & M
Reduce duration of healthcare
Reduce cost of healthcare
Produce no adverse effects
Have no adverse consequences

Question 16

What is the normal flora found in the nasopharynx? (4)

Answer 16

Staph
Strep (mainly pneumoniae)
Moraxella catarrhalis
Hemophilus

Question 17

What is the normal flora found on the skin? (2)

Answer 17

Staph epidermidis
Staph aureus

Question 18

What is the normal flora found in the oropharynx? (3)

Answer 18

Strep: viridans

1. pyogenes (strep throat)
2. pneumoniae

Moraxella catarrhalis
Hemophilus

Question 19

What is the normal flora found in the intestine? (3)

Answer 19

Bacteroides fragilis
Strep
Enterococci

Question 20

What is the normal flora of the female GU tract? (2)

Answer 20

Strep
Staph

Question 21

What does ideal therapy consist of? (5)

Answer 21

Active against most likely pathogen
Given in an appropriate dosage
Given at appropriate time
Safe
Administered for shortest period

1. Minimize adverse effects
2. Minimize resistance
3. Minimize cost

Question 22

How much Ancef do you need to give a patient:

< 50 kg
normal adult
> 120 kg

Answer 22

1 gram

2 grams

3 grams

Question 23

Within what time frame must antibiotics be administered?

What about vanc?

Answer 23

1 hr

2 hrs

Question 24

You must have the antibiotics delivered before the tourniquet is inflated. True or false?

Answer 24

true, duh

Question 25

True allergies to antibiotics are rare. True or false?

Answer 25

true

Question 26

What is considered a "clean" wound? (20

Answer 26

Closed, elective procedure No pus involved Ie. neurosurgery

Question 27

What is considered "clean-contaminated"? (2)

Answer 27

GI,GU, biliary Re-operation within 7 days Ie. when there is pus involved. Example: **VP SHUNT because down by GI, NONRUPTURED APPENDICITIS**

Question 28

What is considered a "contaminated" wound?

Answer 28

Acute inflammation Penetrating trauma (\<4hrs) Ie. RUPTURED APPENDICITIS

Question 29

What is considered a "dirty" wound? (3)

Answer 29

Preexisting infection Perf GI Trauma (\>4hr)

Question 30

What type of classification is this type of wound? Elective, not emergency, nontraumatic, primarily closed; no acute inflammation; no break in technique; respiratory, gastrointestinal, biliary and genitourinary tracts not entered

Answer 30

Clean

Question 31

What type of classification is this type of wound? Urgent or emergency casen; elective opening of respiratory, gastrointestinal, biliary or genitourinary tract with minimal spillage (e.g., appendectomy) not encountering infected urine or bile; minor technique break

Answer 31

Clean-contaminated

Question 32

What type of classification is this type of wound? Nonpurulent inflammation; gross spillage from gastrointestinal tract; entry into biliary or genitourinary tract in the presence of infected bile or urine; major break in technique; penetrating trauma \< 4 hours old; chronic open wounds to be grafted or covered

Answer 32

Contaminated

Question 33

What type of classification is this type of wound? Purulent inflammation (e.g., abscess); preoperative perforation of respiratory, gastrointestinal, biliary or genitourinary tract; penetrating trauma \> 4 hours old

Answer 33

Dirty

Question 34

What type of antibiotic do you give in neuro cases?

Answer 34

Nafcillin

Question 35

What are the penicillinase-resistant antibiotics? (3)

Answer 35

Methiciliin Oxacillin Nafcillin

Question 36

What is a PCN with beta-lactamase inhibitor?

Answer 36

Ampicillin-sulbactam

Question 37

Name widely used: aminoglycosides (2) lincomycin glycopeptide flouroquinolones

Answer 37

Gentamicin, Tobrammycin Clindamycin Vancomycin Ciprofloxacin, Levofloxacin

Question 38

What cephalosporin: ``` more Gram (-) in GI more Gram (+) on skin ```

Answer 38

Cefoxitin 2nd generation

Question 39

What generation cephalosporin is ceftazidime and when is it often used?

Answer 39

3rd lung transplants