E4: Intro To Surg Flashcards by Katie Seils

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

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

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What is the SCIP infection 1 guideline?

Prophylactic antibiotic received within 1 hour prior to surgical incision

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What is the SCIP infection 2 guideline?

Prophylactics abx selection for surgical patients

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What is the SCIP infection 3 guideline?

Prophylactics abx discontinued within 24 hours after surgery end time

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What is the SCIP infection 4 guideline?

Cardiac surgery patients with controlled 6am postoperative serum glucose measurement

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What is the SCIP infection 5a guideline?

Postoperative surgical site infection diagnosed during index hospitalization

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What is the SCIP infection 6 guideline?

Surgery patients with appropriate hair removal

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What is the SCIP infection 7 guideline?

Colorectal surgery patients with immediate postoperative normothermia

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What is ASA classification?

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

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What are the 6 ASA classifications?

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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What are the 4 mallampati scores?

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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When should you obtain a preoperative CXR?

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

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When should you obtain a pre-operative EKG?

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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What factors increase risk for pulmonary surgical complications ?

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

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

H&P
CXR
PFTs
ABGs
Pulmonary consult

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

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

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

Hypo or hyperglycemia, infections

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

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How is adrenal insuffiency managed both pre and post operatively?

Cover with additional steroids peri-operatively

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

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What are the 4 basic incisions?

Thoracotomy, midline, transverse, and McBurney

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What is the most commonly used position for general surgery?

Supine

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What is the trendeleberg position used for?

Increases exposure to pelvic organs

- also used to place central lines

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What is the reverse trendeleberg position used for?

-Enhances exposure to upper abdominal viscera

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What is the sitting position used for?

Cranitomites

- Cervical spine surgery

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What is the lithotomy position used for?

Urologic procedures
GYN procedures
rectal surgery

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What is the prone position used for?

Spinal surgery

What is the lateral position used for?

Thoracotomies, nephrectomies, and retroperitoneal approaches

What is the difference between laparotomy and laparoscopy?

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

How does laparoscopy work?

-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

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

-Shoulder pain, referred pain from CO2 under the diaphragm

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

Fever due to medications, blood products, or malignant hyperthermia

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

Nosocomial infections, UTI, and aspiration PNA

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

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

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

Infection/abscess

What is the treatment for post operative atelectasis?

Incentive spirometry, cough, deep breathing, ambulation

What is the treatment for post operative wound infection?

Opening the wound and antibiotics

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

Back to OR

What is the treatment for post operative aspiration PNA?

Pulmonary toilet and ABX

When does a post operative wound infection commonly occur?

POD 3-5

What accounts for 50% of all post operative complications?

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

What is the management of seromas and hematomas?

- Drains help prevent seromas | - Expanding hematomas must be evacuated and bleeding controlled, small hematomas may be left alone

What is the the management for fascial wound dehiscence?

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

What is the biggest source of post operative infection?

The patient (community vs hospital acquired)

What is the optimal time for prophylactic antibiotics preoperatively?

30-60 minutes prior

What antibiotics are most commonly used for prophylactic treatment preoperatively?

1st and 2nd generation cephalosporins

What is atelectasis?

Diminished volume affecting all or part of a lung

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

Atelectasis

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

Atelectasis

What causes post operative intra-abdominal infections?

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

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

E.coli, enterobacter, bacteriodes

What is the management of a post operative wound infection?

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

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

Staph and strep

What are the different kind of debridement?

``` Sharp Mechanical Autolytic Enzymatic Biologic ```

What is autloytic debridement?

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

What is enzymatic debridement?

- Uses chemical enzymes to turn necrotic tissue into slough | - Best used on wounds with hard eschar and or large amounts of necrotic tissue

What are the pros and cons of autlytic debridement?

Pros: very selective, safe, painless Cons: slow and cannot be used for infected wounds

What is mechanical debridement?

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

What are the pros and cons of mechanical debridement?

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

What is sharp surgical debridement?

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

What are the pros and cons of sharp surgical debridement?

-pros: fast and selective Cons: painful and costly if OR is required

What is biologic debridement?

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

What are the contraindications to negative pressure wound therapy?

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