basic surgical concerns Flashcards

1
Q

What findings suggest a high risk of surgical complications?

A

age >70, FEV1/FVC 45, pulmonary edema, MI in past 30 days, poorly controlled arrhythmias, severe valvular disease, poor LVEF, Crt

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2
Q

When is the risk of post-op MI greatest?

A

within the first 48 hrs after surgery

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3
Q

How long before surgery should pts stop smoking?

A

ideally 8 wks

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4
Q

When is a pre-op CXR useful?

A

age >50, hx of pulm disease, anticipated surgical time >3 hrs

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5
Q

What medication can be given to protect the kidneys in pts with renal insufficiency who are expected to receive intraoperative contrast?

A

acetylcysteine

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6
Q

When can you restart LMWH after the removal of an epidural catheter? Why the delay?

A

at least 2 hrs afterward to prevent formation of an epidural hematoma

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7
Q

When can you restart LMWH in a patient who had a recent thromboembolism and surgery?

A

restart 12 hrs post-operatively

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8
Q

When do different post-op fevers arise?

A

PNA: days 3-5; often have a productive cough and findings on CXR
UTI: days 3-5
Would infection or catheter infection: days 5-8 post op
DVT, PE, meds, transfusion rxns can all cause fevers at any time

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9
Q

What are the different types of wounds (ie clean, dirty, etc)?

A

clean: incision through disinfected skin w/o GI or resp entry: 1% infection rate
clean-contaminated: incision through disinfected skin with GI or resp entryl 2-8% infection rate
contaminated: contact of wound with GI or GU contents, traumatic woulds. 6-15% infection rate
dirty: established infection in tissue before surgery

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10
Q

What is secondary intention wound approximation?

A

wound left open and allowed to wheal through epithelialization; higher risk of infection

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11
Q

How do you care for closed vs open wounds post-op?

A

closed wounds need dressings for an additional 48 hrs after closure
open wounds require debridement and special dressings

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