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Emergency/surg > E4: Intro To Surg > Flashcards

E4: Intro To Surg Flashcards

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1
Q

What is the surgical care improvement project (SCIP) protocol?

A

-A protocol developed to improve patient care and prevent avoidable deaths due to infection

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2
Q

What is the SCIP infection 1 guideline?

A

Prophylactic antibiotic received within 1 hour prior to surgical incision

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3
Q

What is the SCIP infection 2 guideline?

A

Prophylactics abx selection for surgical patients

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4
Q

What is the SCIP infection 3 guideline?

A

Prophylactics abx discontinued within 24 hours after surgery end time

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5
Q

What is the SCIP infection 4 guideline?

A

Cardiac surgery patients with controlled 6am postoperative serum glucose measurement

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6
Q

What is the SCIP infection 5a guideline?

A

Postoperative surgical site infection diagnosed during index hospitalization

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7
Q

What is the SCIP infection 6 guideline?

A

Surgery patients with appropriate hair removal

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8
Q

What is the SCIP infection 7 guideline?

A

Colorectal surgery patients with immediate postoperative normothermia

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9
Q

What is ASA classification?

A

-Used by anesthesia providers to indicate overall preoperative heath and predict operative risk

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10
Q

What are the 6 ASA classifications?

A

I: Health
II: Mild systemic disease
III: Severe systemic disease
IV: Severe systemic disease that is a threat to life
V: A moribund person not expected to survive without the operation
VI: Declared brain dead person who organs are being removed for donation

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11
Q

What are the 4 mallampati scores?

A

Class I: Complete visualization of the soft palate
Class II: Complete visualization of the uvula
Class III: Visualization of only the base of the uvula
Class IV: Soft palate is not visible at all

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12
Q

When should you obtain a preoperative CXR?

A

If older than 50yo or history of cardiac and or pulmonary disease

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13
Q

When should you obtain a pre-operative EKG?

A
  • Men >45
  • Women >55
  • Known hx of cardiac disease
  • History of diuretic use
  • Hx of DM and or HTN
  • Major surgical procedure planned
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14
Q

What factors increase risk for pulmonary surgical complications ?

A
  • Cigarette smoking: #1 factor, encourage to stop two months before surgery
  • COPD, asthma
  • Thoracic and upper abdominal procedures
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15
Q

What is the pre-op assessment for those at high risk for pulmonary complications?

A
  • H&P
  • CXR
  • PFTs
  • ABGs
  • Pulmonary consult
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16
Q

What is the pre-operative assessment for patients with diabetes?

A
  • Average glucose levels, A1C
  • EKG
  • Prior or surgery patients are NPO after midnight so insulin regimens are adjusted as needed
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17
Q

What are the post operative risks for diabetics and how is the managed?

A
  • Hypo or hyperglycemia, infections

- Follow BS every 6hours, maintain between 150-200 and cover with sliding scale

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18
Q

How is adrenal insuffiency managed both pre and post operatively?

A

Cover with additional steroids peri-operatively

  • Pre-op: 100mg hydrocortisone
  • Post-op: 100mg/day tapered over 5 days
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19
Q

What are the 4 basic incisions?

A

Thoracotomy, midline, transverse, and McBurney

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20
Q

What is the most commonly used position for general surgery?

A

Supine

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21
Q

What is the trendeleberg position used for?

A
  • Increases exposure to pelvic organs

- also used to place central lines

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22
Q

What is the reverse trendeleberg position used for?

A

-Enhances exposure to upper abdominal viscera

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23
Q

What is the sitting position used for?

A
  • Cranitomites

- Cervical spine surgery

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24
Q

What is the lithotomy position used for?

A
  • Urologic procedures
  • GYN procedures
  • rectal surgery
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25
Q

What is the prone position used for?

A

Spinal surgery

26
Q

What is the lateral position used for?

A

Thoracotomies, nephrectomies, and retroperitoneal approaches

27
Q

What is the difference between laparotomy and laparoscopy?

A

-Laparotomy is an open, large incision. Laparoscopy is small incisions with the aid of a camera

28
Q

How does laparoscopy work?

A

-Minimally invasive surgical technique that uses gas (usually CO2) to insufflate the peritoneum and instruments are manipulated through ports with are introduced through small incisions with video camera guidance

29
Q

What kind of post operative pain is common with laparoscopic procedures?

A

-Shoulder pain, referred pain from CO2 under the diaphragm

30
Q

What does a post operative fever that occurs immediately or a couple hours after surgery indicate?

A

Fever due to medications, blood products, or malignant hyperthermia

31
Q

What does a post operative fever that occurs during the first week after surgery indicate?

A

Nosocomial infections, UTI, and aspiration PNA

32
Q

What does a post operative fever that occurs within 1-4 weeks after surgery indicate?

A

Surgical site infection, infection from central vernous catheters, abx associated diarrhea

33
Q

What does a delayed post operative fever ( >1 month after surgery) indicate?

A

Infection/abscess

34
Q

What is the treatment for post operative atelectasis?

A

Incentive spirometry, cough, deep breathing, ambulation

35
Q

What is the treatment for post operative wound infection?

A

Opening the wound and antibiotics

36
Q

What is the treatment of post operative leakage of bowel anastomoses?

A

Back to OR

37
Q

What is the treatment for post operative aspiration PNA?

A

Pulmonary toilet and ABX

38
Q

When does a post operative wound infection commonly occur?

A

POD 3-5

39
Q

What accounts for 50% of all post operative complications?

A

Infection, frequently caused by Cl Austria is or group A strep

40
Q

What is the management of seromas and hematomas?

A
  • Drains help prevent seromas

- Expanding hematomas must be evacuated and bleeding controlled, small hematomas may be left alone

41
Q

What is the the management for fascial wound dehiscence?

A
  • Associated with 15% mortality and potential for evisceration
  • Sudden drainage of pink, serosanguinous salmon colored peritoneal fluid
  • Book OR!
42
Q

What is the biggest source of post operative infection?

A

The patient (community vs hospital acquired)

43
Q

What is the optimal time for prophylactic antibiotics preoperatively?

A

30-60 minutes prior

44
Q

What antibiotics are most commonly used for prophylactic treatment preoperatively?

A

1st and 2nd generation cephalosporins

45
Q

What is atelectasis?

A

Diminished volume affecting all or part of a lung

46
Q

What is the most common cause of fever within the first 48 hours after surgery?

A

Atelectasis

47
Q

What is the most common pulmonary complication in patients following thoracic and upper abdominal procedures?

A

Atelectasis

48
Q

What causes post operative intra-abdominal infections?

A

Usually the results of a surgical complication (dehiscence of a suture line) can lead to either a localized abscess or peritonitis

49
Q

What are the most common etiologies of intra-abdominal infections?

A

E.coli, enterobacter, bacteriodes

50
Q

What is the management of a post operative wound infection?

A

-I&D or opening of incision (wound care, abx for severe infections)

51
Q

What are the most common etiologies of post operative wound infections?

A

Staph and strep

52
Q

What are the different kind of debridement?

A 
Sharp
Mechanical
Autolytic
Enzymatic
Biologic
53
Q

What is autloytic debridement?

A

-Uses the body’s own enzymes to liquefy necrosis debris and maintain moist wound environment

54
Q

What is enzymatic debridement?

A
  • Uses chemical enzymes to turn necrotic tissue into slough

- Best used on wounds with hard eschar and or large amounts of necrotic tissue

55
Q

What are the pros and cons of autlytic debridement?

A

Pros: very selective, safe, painless

Cons: slow and cannot be used for infected wounds

56
Q

What is mechanical debridement?

A
  • Wet to dry dressing: apply wet dressing, wait for it to dry, and then remove dressing
  • Hydrotherapy, continuous pulse irrigation (CPI)
57
Q

What are the pros and cons of mechanical debridement?

A

Pros: Cheap

Cons: nonselective and traumatic, painful, hydrotherapy can cause maceration and risk of exposure to waterborne pathogens

58
Q

What is sharp surgical debridement?

A

Removing necrotic tissue with sharp instrument

  • can be performed in operating room or at bedside depending on extent of necrotic tissue
  • Best used with large amounts of necrotic tissue especially in infected wounds
59
Q

What are the pros and cons of sharp surgical debridement?

A

-pros: fast and selective

Cons: painful and costly if OR is required

60
Q

What is biologic debridement?

A

Maggot debridement therapy (MDT): disinfected fly larvae are placed in a wound for 2-3 days, confined to wound by special dressing
-Maggots dissolve necrotic and infected debris, disinfect wound, and speed the rate of healing

61
Q

What are the contraindications to negative pressure wound therapy?

A

-Necrotic tissue, untreated osteomyelitis, fistula to body cavity, malignancy in wound, or exposed artery or vein

Emergency/surg (9 decks)

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