Corrections Flashcards
When is a VRIII required for diabetics in surgery?
1) poorly controlled diabetes (HbA1c ≥69 mmol/mol)
or
2) surgery requires long fasting period of more than 1 missed meal
Mx of OD insulins in peri-operative period?
Day prior –> reduce dose by 20%
Day of –> reduce dose by 20% (if morning or afternoon surgery)
What should you aim to reduce glucose & ketones by per hour in DKA?
Glucose –> reduce by 3-5 mmol/l/hr
Ketones –> reduce by 0.5 mmol/l/hr
What is the most commonly used vein for a central line?
IJV
What does the max height of the wave on an arterial line waveform indicate?
Systolic BP
What does the lowest point of the wave on an arterial line waveform indicate?
Diastolic BP
What marks the end of systole and beginning of diastole on an arterial line waveform?
Dichrotic notch
What is the most common use of a Vas Cath? (1)
Short-term haemodialysis
What abdominal findings may be seen in tricuspid regurgitation? (2)
- Ascites
- Pulsatile liver
What type of catheter involves a small chamber under the skin at the top of the chest? (1)
Where does this type of catheter enter the venous system? (1)
Where is the tip located? (1)
Portacath
Subclavian vein
SVC
Where does the central line tips terminate?
If inserted into the subclavian vein or IJV –> terminate in the SVC
If inserted into the femoral vein –> terminate in the IVC
Which type of line is used if the patient is going to be going home with the line?
Tunnelled e.g. Hickman
Which two factors contribute to the mean arterial pressure? (2)
1) systemic vascular resistance
2) cardiac output
What is the APACHE score used for? (1)
To predict mortality at the time of admission to ICU
What type of catheter is a Swan-Ganz catheter? (1)
Where is the tip of the catheter located? (1)
What does measuring the pressure in this area indicate? (1)
Pulmonary artery catheter
Pulmonary artery
LA pressure
Should blood products be ordered prior to an elective LSCS?
No just G&S
When should ACEi be stopped prior to surgery?
Day before
What is the best diagnostic investigation for a flail chest?
CT scan of chest
Mx of pre-op anaemia:
a) >6 weeks until surgery
b) <6 weeks until surgery
a) oral iron
b) IV iron
VTE prophylaxis in patients undergoing elective hip replacement?
Mechanical + pharmacological prophylaxis
When should LMWH be started following a hip replacement?
6 hours after operation.
Mx of sulfonylureas (e.g. gliclazide) on day prior & day of surgery?
Take medication day PRIOR to surgery.
Omit on day of surgery (exception is morning surgery in patients who take BD - can have the afternoon dose).
What enzyme is deficient in suxamethonium apnoea?
Acetylcholinesterase
