Care of The Surgical Patient Flashcards
How long should clopidogrel be stopped before surgery?
7 days
When should warfarin be stopped before surgery?
5 days
Advice to patients with medically managed T2DM on day of surgery?
Omit morning dose of gliclazide, take metformin as usual
What are the basic tenants for ERAS (enhanced recovery after sugrery)?
Reduction in ‘Nil By Mouth’ times (clear fluids up to 2 hours pre-surgery)
Pre-operative carbohydrate loading
Minimally invasive surgery
Minimising the use of drains and nasogastric tubes
Rapid reintroduction of feeding post-operatively
Early mobilisation
What should be transfused to patients with massive haemorahge?
Blood products and clotting factors (fresh frozen plasma)
When should platelets be tranfused?
Active bleeding and thrombocytopenia (platelets < 50)
When might prothrombin complex concentrate be transfused?
Patients taking warfarin that are actively bleeding
Risk factors for post op N&V?
Female History of motion sickness or previous PONV Non-smoker Use of postoperative opiates Younger age Use of volatile anaesthetics
What is ondansetron?
5HT3 receptor antagonist
anti-emetic
In what patients should ondansetron be avoided?
Prolonged QTc interval
What is cyclizine?
Histamine (H1) receptor antagonist
In which patients must cyclizine be used with caution?
Elderly
HF
Where is CCK (choleystokinine) released from?
Duodenum
What electrolyte disturbances may normal saline cause?
Hypernatermia
Metabolic acidosis due to Cl-
Post up pyrexia- 5 ws?
Wind - days 1-2 (chest infx)
Water - days 3-5 (UTI)
Walking - days 4-6 (VTE)
Wound - days 5-7 (surgical site infection, intrabdominal collection)
Wounder about drugs - days 7+ (blood products, IV cannulas, analgesia)
Common urinary problems post-surgery?
Urinary retention
UTI
AKI - cathterisation, surgery complications
Respiratory surgical complications?
Atelectasis - airway obstruction due to bronchil secretions
Chest infection/pneumonia
PE
ARDS
What are the major causes of death post-surgery?
DVT
VTE
DVT investigation?
Doppler USS
Most common sign of PE?
Tachycardia
What is wound dehiscense?
Serious complication with mortality up to 30%
7-10 days post op
Steroid dressing covering whole wound
Analgesia
Early return to theatre for resuturing under GA
Prevention of post-op complications?
Weight control Optimal nutritional status Correct anaemia Adeuqete post op analgesia Prophylactic abx Shorter operative times reduce incidence of ileus VTE prophylaxis Fluid balance Catheters (prevent retention or AKI)
How can insufficient pain management cause respiratory complications?
Shallow breathing
Atelectisis, resp infection
Common anesthetics?
Volatile liquid
Nitrous oxide
IV: propofol (good induction agent and has anti emetic affects)
Complications of GA?
Anaphylaxis Aspiration pneumonitis Peripheral nerve damage (lying still for long time) Damage to teeth Air embolisim Mallignant hyperthermia Pneumothorax
Post op complications that tend to be associated with family history?
Mallignant hyperthermia
Immediate complications post-op?
Primary haemorrhage Reactionary haemorrhage Basal atelectasis Shock Low UO
Early post-op complications?
Pain Acute confusion N+V Fever Secondary haemorrhage Pneumonia Wound or anastomoses dehistence DVT Acute urinary retention/UTI Post op wound infection Paralytic illeus Bowel obstruction due to fibronous adhesions