Day 5 - ICU & Surgery Quiz

Question 1

Causes of fever in postop period

Answer 1

Wind (Atelectasis possibly PNA), Water (UTI), Walking (DVT), Wound (Infection, POD 5-8), Wayne (“vein” thrombophlebitis), & Wonder Drugs (antibx); Sinusitis (especially if NG tube)

Question 2

Usual lab panel in pt p/w generalized ab pain

Answer 2

CBC w/ diff, Chem 14 (lytes, BUN/Cr, & LFTs), B-HCG in females, U/A, Amylase, Lipase, Stool guaiac; If over age 45, may be atypical CP - EKG & cardiac enzymes

Question 3

Usual time frame for stopping Warfarin prior to surgery

Answer 3

3-4 days; Coagulation factors have shorter half life

Question 4

Normal time frame for stopping ASA prior to surgery

Answer 4

5-7 days; Platelets have longer half-life than coagulation factors (e.g., 3-4 days for warfarin)

Question 5

Interventions helpful in optimizing lung fxn in postop pts w/ pre-existing lung disease

Answer 5

Normally - IS, Pain control, Deep breathing, PT; Pre-existing lung disease - also add bronchodilators (Albuterol or Levalbuterol), inhaled steroids

Question 6

When greatest risk for postop MI

Answer 6

Within 48 hrs postop

Question 7

Recommended periop regimen for pt w/ known CAD

Answer 7

Beta blockers, Telemetry monitoring

Question 8

Vasopressors: theoretically causes renal vasodilation

Answer 8

Dopamine

Question 9

Vasopressors: High dose optimize alpha1 vasoconstriction

Answer 9

Epinephrine

Question 10

Vasopressors: ADH analog

Answer 10

Vasopressin

Question 11

Vasopressors: Best choice for anaphylatic shock

Answer 11

Epinephrine

Question 12

Vasopressors: Best choice for septic shock

Answer 12

NE

Question 13

Vasopressors: Best choice for cardiogenic shock

Answer 13

Dobutamine

Question 14

Vasopressors: Causes vasoconstriction but with bradycardia

Answer 14

Phenylephrine

Question 15

Immunodef increases risk for transfusion reaction

Answer 15

IgA deficiency

Question 16

Blood products most appropriate: Severe anemia 2/2 autoimmune hemolytic anemia

Answer 16

Packed RBCs

Question 17

Blood products most appropriate: Hemophilia

Answer 17

Specific clotting factor (e.g., VIII in A, IX in B)

Question 18

Blood products most appropriate: DIC

Answer 18

FFP; If platelets severely low, may need to replace them as well

Question 19

Blood products most appropriate: Shock due to trauma or postpartum hemorrhage

Answer 19

Whole blood or Packed RBCs

Question 20

Blood products most appropriate: Maintain bp during large volume pericentesis

Answer 20

Albumin

Question 21

Blood products most appropriate: Hemorrhage due to warfarin overdose

Answer 21

FFP (while Vitamin K is starting to exert its effect)

Question 22

Blood products most appropriate: Need for vWF rich product

Answer 22

Cryoprecipitate

Question 23

Blood products most appropriate: Thrombocytopenia

Answer 23

Platelets

Question 24

Preferred vessels for placement of Swan-Ganz catheter

Answer 24

Right IJ or Left Subclavian

Question 25

Lab findings suggest hepatic disease during preop w/u

Answer 25

Elevation of PT/PTT, Decreased platelets, Elevated bili, LFTs elevated or decreased (if cirrhotic), Decreased lipids, Decreased Albumin

Question 26

Interventions to protect kidney s during times of anticipated insults

Answer 26

N-acetylcysteine for 24 h before & after; IV fluids; Sodium bicarbonate right before IV contrast & 6 h after

Question 27

Typical post op fever w/u

Answer 27

Assess pts; CXR, CBC w/ diff, UA, urine & blood cultures; Risk of DVT or sinusitis