Care of the Surgical Patient Flashcards
what abnormal blood results would be seen in a dehydrated pt.?
increase urea
decreased haemocrit
what observations will be seen in hypovolemic shock?
increased HR and RR
decreased BP
oliguria
daily requirements of water, Na+, Cl-, K+ and glucose
water: 3L Na+: 150mmol Cl-: 150mmol K+: 100mmol glucose: 125-150g
kilocalorie requirements for an adult pt.
25kcal/kg/day
to
45kcal/kg/day if post-op
perioperative risk factors for post-op DVT
age male corticosteroid use COPD recent weight loss disseminated Cancer low albumin and low haemocrit Hx of DVT trauma smoking hypercoaguable disorders COCP
intraoperative risk factors for post-op DVT
haemorrhage injured veins blood transfusion GA fat emboli length of surgery and hence immobility
post-operative risk factors for post-op DVT
inactivity MI coma pneumonia UTIs
how do compression stockings reduce risk of DVT?
reduced vein diameter –> increased pressure –> increased blood flow to heart –> decreased haemostasis and clots
what medication is used for thromboprophylaxis due to surgery?
dalteparin 5000U
signs of hypoglycaemia
shakiness dizziness sweating hunger headache blurry vision
Ax treatment of inpatient UTI
uncomplicated: trimethoprim PO 200mg bd 3 days
complicated: trimethoprim PO 200mg bd 5 days or co-amoxiclav PO 625mg tds (aka Augmentin - is first line in males)
Ax treatment of pyelonephritis
co-amoxiclav PO 625mg tds 14 days
if NBM then co-amoxiclav IV 1.2g tds 14 days (switch to oral when possible)
if penicillin allergic then ciprofloxacin PO 500mg bd 7 days
if penicillin allergic and NBM then meropenem IV 500mg qds
Ax treatment of meningitis
ceftriaxone IV 2g bd (duration depends on culture) consider also giving dexamethasone sodium phosphate IV 10mg qds
if immunocompromised or >55y/o consider listeria so also give amoxicillin IV 2g 4 hourly
Ax treatment of unknown origin sepsis
flucloxacillin IV 1g qds & metronidazole IV 500mg bd & gentamicin IV 7mg/kg of
if penicillin allergic then give meropenem IV 500mg qds
Ax treatment of CA pneumonia
CURB Score (CS) CS 0-1: amoxicillin PO 500mg tds CS 2: amoxicillin PO 1g tds & doxycycline PO 200mg od CS 3-5: co-amoxiclav IV 1.2g tds & doxycycline PO 200mg od if penicillin allergic --> CS 1-2: doxycycline PO 200mg of CS >3: meropenem IV 500mg qds & doxycycline PO 200mg of if NBM then sub doxycycline with clarithromycin IV 500mmg bd
Ax treatment of HA pneumonia
moderate: co-amoxiclav PO 625mg tds
NBM: co-amoxiclav IV 1.2g tds
penicillin allergic: doxycycline PO 200mg or meropenem IV 500mg qds if NBM
Ax treatment of C. Difficile
no markers of severe disease: metronidazole PO 400mg tds 10 days
markers of severe disease: vancomycin PO 125mg qds 10 days
Ax treatment of cellulitis
mild: flucloxacillin PO 500mg qds 7 days
severe: flucloxacillin IV 2g tds 7days
if penicillin allergic
mild: doxycycline PO 200mg od 7days
severe: vancomycin 1g ods
causes of AKI
pre-renal: hypovolaemia (haemorrhage, GI losses, renal losses, burns), reduced CO (cardiac/liver failure, sepsis, drugs)
renal: drugs (ACEi, NSAIDs), vascular (vasculitis, thrombosis, thromboembolism, dissection), glomerular (glomerulonephritis), tubular (ischaemia, rhabdomyolysis, myeloma, contrast), interstitial (interstitial nephritis)
post-renal: obstruction (renal stones, pyonephrosis, blocked catheter, pelvic mass, enlarged prostate, cervical carcinoma, retroperitoneal fibrosis)
what is a massive blood transfusion in adults?
replacement of >1 blood volume in 24hrs or >50% of blood volume in 4hrs
occurs due to severe trauma, ruptured AAA and surgical/obstetric complications
mortality is high due to hypotension, acidosis, coagulopathy, shock and the condition of the pt. the lethal triad = pts with acidosis, hypothermia and coagulopathy
what are the components of FFP and cryoprecipitate?
FFP –> plasma frozen to -35C, used to treat large volume bleeds and DIC
cyro –> made from FFP that is frozen and repeatedly thawed to concentrate the clotting factors, used to treat DIC, advanced liver disease, renal/liver failure, and hypofribrinogeneamia
list some early and late complications of blood transfusions
early (<24hrs): haemolytic reaction, sepsis, anaphylaxis, circulatory overload, ARDS
late (>24hrs): graft vs host disease, infection, post-transfusion purpura
what is assessed in the EWS?
RR O2 sats if the pt is on oxygen temperature (normal 36.1-38) systolic BP HR conscious level (AVPU)
causes of post-operative pyrexia
early (days 0-5): blood transfusion, cellulitis, UTI, pulmonary atelectasis, physiological systemic inflammatory reaction
late (days >5): venous thromboembolism, pneumonia, wound infection, anastomotic leak, PE (typically occurs day 10-12 when a pt is straining over a stool)
causes of increased urea:creatinine ratio
(Drivers Can Use GPS) Dehydration/prerenal failure Corticosteroids GI haemorrhage Protein rich diet Severe catabolic state
causes of decreased urea:creatinine ratio
(i am a SIMPLE SR) Severe liver dysfunction Intrinsic renal damage Malnutrition Pregnancy Low protein diet SIADH Rhabdomyolysis
what increases the risk of having a DVT?
smoking immobility dehydration hyperlipidaemia age female trauma/ surgery due to stress response and increased clotting AF blood abnormalities - HbS/ thalassaemia
