Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgical Recall > Emma Holliday for Surgery: Part I > Flashcards

Emma Holliday for Surgery: Part I Flashcards

1
Q

What absolute findings contradict going in for surgery?

A

Diabetic Coma, DKA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What poor nutrition findings contradict going to surgery?

A

Albumin less than 3, transferrin less than 200 and weight loss more than 20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What severe liver failure findings contradict surgery in the pre-op evaluation?

A

bili > 2, PT > 16, ammonia > 150, or encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Can you get surgery if you smoke?

A

Stop smoking 8 weeks prior to surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

If your patient is on a CO2 retainer, what do you need to be sure of in post-op?

A

Go easy on the O2 in the post-op period, can suppress respiratorydrive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does Goldman’s Index tell us?

A

Tells you who is at greatest risk for surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

6 qualifiers in Goldman’s Index?

A
  1. CHF
  2. MI w/in 6 months
  3. Arrhythmia
  4. Old (age >70)
  5. Surgery is emergent
  6. AS, poor medical condition, surg in chest/abd
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If a patient has CHF, how do you determine if they can have surgery?

A

Ejection fraction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

If someone has had an MI in the last 6 months, how do you evaluate if they are fit for surgery?

A

EKG –> stress test –> cardiac cath –> revasc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

If someone has AS, poor medical condition, surg in chest/abd, what should you check prior to surgery?

A

Listen for murmur of AS-

Late systolic, crescendo-decrescendo murmur that radiates to carotids. ↑ with squatting, ↓ with decr preload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

5 drugs to stop before surgery

A 
Aspirin
NSAIDs
vit E (2wks)
Warfarin (5 days) –drop INR to less than 1.5
Insulin - Take morning dose only
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the worry if BUN > 100?

A

There is an increased risk of post-op bleeding 2/2 uremic platelet dysfunction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What would you expect on coag pannel with a high BUN?

A

Normal platelets but prolonged bleeding time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is “Assist-control” on vent settings?

A

set TV and rate but if pt takes a breath, vent gives the volume.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is “Assist-control” on vent settings?

A

set TV (tidal volume) and rate but if pt takes a breath, vent gives the volume.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

You have a patient on a vent…

•Best test to evaluate management?

A

ABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

If a patient’s PaO2 is low?

A

Increase FiO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

If a patient’s PaO2 is high?

A

Decrease FiO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

If PaCO2 is low (pH is high)?

A

Decrease rate or tidal volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

If PaCO2 is high (pH is low)?

A

Increase rate or Tidal volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which is more efficient to change, tidal volume or rate?

A

Tidal volume

22
Q

pH indicating acidosis

A

Less than 7.4

23
Q

If your patient’s pH is low, what do you check next

A

HCO3 and pCO2

24
Q

If HCO2 and pCO2 are high when pH is low, what do we have going on?

A

Resp. acidosis

25
Q

If pH is low, HCO2 is low and pCO2 is low, what’s going on?

A

Metabolic acidosis

26
Q

Formula for anion gap

A

= ([Na+] + [K+]) − ([Cl-] + [HCO3−]) = 16 mEq/L

= [Na+] − ([Cl−] + [HCO3−]) =12 mEq/L

Anion Gap = Sodium - (Chloride + Bicarbonate) (Bicarbonate may also be referred to as “total CO2” or “carbon dioxide”.)

27
Q

Gap acidosis =

A

MUDPILES (>12)

M — Methanol
U — Uremia (chronic kidney failure)
D — Diabetic ketoacidosis
P — Propylene glycol (“P” used to stand for Paraldehyde but this substance is not commonly used today)
I — Infection, Iron, Isoniazid, Inborn errors of metabolism
L — Lactic acidosis
E — Ethylene glycol (Note: Ethanol is sometimes included in this mnemonic as well, although the acidosis caused by ethanol is actually primarily due to the increased production of lactic acid found in such intoxication.)
S — Salicylates

28
Q

Gap acidosis causes =

A

MUDPILES (>12)

M — Methanol
U — Uremia (chronic kidney failure)
D — Diabetic ketoacidosis
P — Propylene glycol (“P” used to stand for Paraldehyde but this substance is not commonly used today)
I — Infection, Iron, Isoniazid, Inborn errors of metabolism
L — Lactic acidosis
E — Ethylene glycol (Note: Ethanol is sometimes included in this mnemonic as well, although the acidosis caused by ethanol is actually primarily due to the increased production of lactic acid found in such intoxication.)
S — Salicylates

29
Q

Non-gap acidosis causes:

A

So basically they have metabolic acidosis without an anion gap that is abnormal

H = hyperalimentation (e.g., starting TPN).
A = acetazolamide use.
R = renal tubular acidosis (Type I = distal; Type II = proximal; Type IV = hyporeninemic hypoaldosteronism.
D = diarrhea
U = uretosigmoid fistula (because the colon will waste bicarbonate).
P = pancreatic fistula (because of alkali loss--the pancreas secretes a bicarbonate-rich fluid).
30
Q

What defines alkalosis?

A

> 7.4

31
Q

If I have a pH >7.4, and HCO3 and PCO2 are both low, what do we have

A

Respiratory alkalosis

32
Q

If pH is >7.4, and HCO3 and pCO2 are high, what do we have?

A

Metabolic Alkalosis

33
Q

If someone is in Metabolic Alkalosis, what do we check next, and what does it indicate?

A

Check urine [Cl].

Less than 20 means vomiting/NG, antacids, diuretics

More than 20 means weird stuff like Conn’s, Bertter’s, Gittleman’s

34
Q

What does a decrease in Na mean?

A

We have gained water

35
Q

Why do we get edema sometimes but not always when we have volume expansion in the body?

A

In primary renal Na retention, volume xpansion is modest and edema does not develop because blood pressure increases until Na excretion matches intake.
- Conn’s syndrome (hyperaldosteronism), Cushings, Renal failure, Nephrotic Syndrome

In secondary Na retention, blood pressure may not increase sufficiently to increase urinary Na excretion until edema develops
- Cirrhosis with ascites, peripheal vasodilation, anaphylaxis, allergic rxn, peritonitis, SBO

36
Q

Causes of volume depletion?

A

We’re either losing a lot of fluid from the kidneys via urine or fluid in other ways:
- Vomiting, diarrhea, fistulae, GI bleed, burns, cystic fibrosis

Renal losses:
- Diuretics, aldosterone deficiency, bad adrenals

37
Q

Clinical signs of volume expansion

A

Edema, pulmonary crackles, ascites, JVD, Hepatojugular reflex, Hypertension

38
Q

Clinical signs of volume depletion

A

Orthostatic decrease in blood pressure and increase in pulse rate, devreased pulse volume and venous pressure, loss of axillary sweating, Dry mucous membranes

39
Q

Normal volume but low sodium?

A

SIADH, Addisons, hypothyroid

40
Q

When do we use 3% saline?

A

Symptomatic (Seizures)

41
Q

When we give saline too quickly

A

Central pontine myelinolysis is a concentrated, frequently symmetric, noninflammatory demyelination within the central basis pontis. One theory proposes that in regions of compact interdigitation of white and gray matter, cellular edema, which is caused by fluctuating osmotic forces, results in compression of fiber tracts and induces demyelination. Prolonged hyponatremia followed by rapid sodium correction results in edema.

42
Q

If we have increased urine sodium, what does it mean?

A

loss of water.

We worry about cerebral edema.

43
Q

If we have increased sodium and we are worrying about loss of water, how do we treat it?

A

Replace with D5W or hypotonic fluid.

44
Q

4 signs of low calcium

A

Numbness, Chvostek, Troussaeu, prolonged QT interval

45
Q

Signs of increased calcium

A

Bones, stones, groans, psycho.

Shortened QT interval

46
Q

Low potassium leads to what?

A

Paralysis, ileus, ST depression, U waves.

Give them Potassium

47
Q

Someone who is hyperkalemic will present how?

A

Peaked T waves, prolonged PR and QRS, sine waves

48
Q

How do we treat hyperkalemia?

A
  1. Give Ca-gluconate
  2. Give insulin with glucose
  3. Kayexalate, albuterol, sodium bicarb.

Last resort = dialysis

49
Q

How much maintence IV fluid do we give?

A

Up to 10 kgs body weight = 100mL/kg/day
10-20 kgs body weight = 50mL/kg/day
Above 20 kgs body weight = 20mL/kg/day

50
Q

Which is better, enteral or parenteral feeding, and why?

A

Enteral (normal PO fluids)

Keeps gut mucosa intact and prevents bacteria from translocating

51
Q

When do we give TPN?

A

Total Parenteral Nutrition

When gut can’t absorb nutrients secondary to physical or functional loss

52
Q

People on TPN are at risk for certain issues. What are they?

A
  • Acalculous cholecystitis
  • Hyperglycemia
  • Liver dysfunction
  • Zinc deficiency

And other electrolyte issues

(Clinical note, our interns were the ones regulating the TPN, sometimes the sodium and potassium would be off because of a bad setting. Always be sure to check this. The TPN should make the labs whatever you want them to be)

Surgical Recall (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions