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Shelf - Surgery > Emma Holliday Ramahi > Flashcards

Emma Holliday Ramahi Flashcards

1
Q

Absolute contraindication to surgery

A

DKA

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2
Q

Nutritional status - three things pre-op to look at.

A

Albumin <3
Weight loss <20%
Transferrin <200

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3
Q

Pre-op smoking

A

Stop 8wks before

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4
Q

Beware of what when smoker coming out of anesthesia?

A

Go easy on O2 - they’re CO2 retainer and can suppress respiratory drive

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5
Q

What is goldman’s index

A

Risks for surgery

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6
Q

Biggest goldman’s index predictor? Check ___ - What classifies as too much risk in this predictor?

A

CHF patient.

Check EF - if <35%, no surgery.

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7
Q

Second most important Goldman’s index

A

MI w/in 6mo.

Check EKG.

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8
Q

Six Goldman’s index

A

CHF, MIw/in 6mo, arrhythmia, >70y, surgery is emergent, AS

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9
Q

Late systolic, crescendo-decrescendo murmur that radiates to carotids.

Increases with squatting, decreases with preload

A

AS

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10
Q

Meds to stop before surgery

A

2wks - aspirin, Voit E, NSAIDs

5d - Warfarin (below 1.5 INR)

Metformin - lactic acidosis

Take 1/2 morning dose of insulin if diabetic

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11
Q

Dialysis 24h before surgery.

Worry in BUN >100?

A

Uremic platelet dysfunction increases risk of post-op bleeding

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12
Q

Use assist-control ventilator setting when…

A

Set TV and rate

But if pt breathes, vent gives the volume

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13
Q

Use pressure control ventilator setting when…

A

Important in WEANING - i.e. pt vented after an accident

Pt rules rate but a boost of pressure is given (8-20)

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14
Q

Use CPAP ventilator setting when…

A

Pt must breath on own but positive pressure given all time

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15
Q

Use PEEP ventilator setting when…

A

Use in ARDS or CHF - pressure given at end of cycle to keep alveoli open

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16
Q

Result of a high PaO2 in a pt on a vent

How do you decrease PaO2?

A

Free radical damage

To fix, decrease FiO2

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17
Q

If PaCO2 is low (pH high) in a pt on a vent, change…

A

Decrease rate or TV

Opposite for high PaCO2

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18
Q

You have metabolic acidosis… next step in evaluation?

A

Check anion gap (Na-[Cl + HCO3]) = 8-12

Gap acidosis = MUDPILES (methanol, uremia, DKA, paraldehyde, INH, lactic acidosis, ethylene glycol, salicylate)

Non-gap acidosis = diarrhea (poop has bicarbonate)

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19
Q

You have metabolic alkalosis… next step?

A

Check urine chloride concentration

[Cl] <20 = vomiting, NG, antacids, diuretics
[Cl] >20 = Conn’s, Gittleman’s, Bartter’s

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20
Q

When do you use 3% (hypertonic) saline?

A

Severe symptoms of hyponatremia (seizures)

Or Na <110

*danger of central pontine myelinolysis

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21
Q

Electrolyte abnormality: Paralysis, ileum ST depression, U waves

A

HypoK

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22
Q

Electrolyte abnormality:

Peaked T waves, prolonged PR and QRS, sine waves.

A

HyperK

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23
Q

Treatment of hyperK

A

Give Ca-gluconate then insulin + glc, kayexalate (poop out K), albuterol and sodium bicarbonate

Last resort is dialysis

24
Q

Electrolyte abnormality:

Numbness, chvostek or trousseau, prolonged QT interval

A

HypoCa

25
Q

Electrolyte abnormality: bones/groans/psycho, shortened QT

A

HyperCa

26
Q

Maintenance IVFs:
Up to 10kg
Next 10kgs
Above 20

A

D5 1/2 NS + 20KCl (if peeing)

First 10kgs = 100mL/kg/day
Next 10kgs = 50
Above 20 = 20

27
Q

Worry about what most in circumferential burns?

A

Compartment syndrome

28
Q

Hep wont work in…

A

AT3 deficiency, HIT (low platelets, clots… tx with leopard in or agatroban)

29
Q

Parkland formula for adults v. Kids

A

Adults - kg x %BSA x (3-4)

Children - kg x %BSA x (2-4)

30
Q

What topical antibiotic for burns does not penetrate eschar and can cause leukopenia?

A

Silver sulfadiazine

31
Q

What topical antibiotic for burns does penetrate the eschar but hurts like hell?

A

Mafenide

32
Q

What topical antibiotic for burns does not penetrate eschar and can cause hypoK and hypoNa?

A

Silver nitrate

33
Q

Urine dipstick positive for blood but microscopic exam negative for RBCs. Dx and check ___

A

Dx - rhabdo

Check K+ (released when cells break)

34
Q

Zone 3 neck trauma - define and how do you w/u?

A

Above angle of mandible

W/u: aortography and triple endoscopy

35
Q

Zone 2 neck trauma - define and how do you w/u?

A

Angle of mandible to the carotid

W/u with 2D doppler +/- exploratory surgery

36
Q

Zone 1 neck trauma - define and how do you w/u?

A

Below the carotid

W/u with aortography

37
Q

Kehr sign

A

Referred pain in left shoulder from ruptured diaphragm

38
Q

Handlebar sign

A

Epigrastric bruising and pain - pancreatic rupture

39
Q

Retroperitoneal fluid found. Stable pt with epigastric pain

A

Duodenal rupture

40
Q

Pattern of nec fasc - fever 104 in POD1

A

SubQ tissue along scarpa’s fascia

41
Q

Nec fasc MCC bugs

A

GABHS, Clostridium perfrigens

42
Q

> ____cm on lateral decubitus or CXR pleural effusion, do what?

A

> 1cm, do thoracentesis

43
Q

LDH <200
LDH ratio eff/serum <0.6
Protein ratio eff/serum <0.5

What is this criteria called and if met, what does it indicate?

A

Light’s criteria

Transudative effusion

44
Q

Valsalva does ____ to preload

AS v. HOCM

A

Decreases preload

AS - murmur gets softer with decreased preload
HOCM - murmur obstruction gets worse with decreased preload

45
Q

R v. L murmur - change in relationship to inspiration

A

Inhale = increased blood to RA/RV; decreased blood to LA/LV

R murmurs get louder with inspiration

46
Q

Complications of pancreatitis

A

Pseudocyst (no cells in cyst)
Hemorrhage
Abscess
Third spacing –COT–> ARDS

47
Q

Chronic pancreatitis –> ______ –> gastric varies

A

Splenic Vein Thrombosis

48
Q

RUQ pain, high Br, high alk-phos

A

Choledocholithiasis (blocked CBD)
See on US
Tx ERCP or surgery

49
Q

RUQ pain, fever, jaundice, HypoTN, AMS

A

Ascending cholangitis (complication of choledocholithiasis)

Abx and ERCP

50
Q

Woman on OCP –> palpable and mass or spontaneous rupture –> hemorrhagic shock

Dx?
Tx?

A

Hepatic adenoma

Dx - US or MRI
Tx - D/c OCPs. Resect if large.

51
Q

MCC of bacterial abscess (three)

A

E. coli, bactericides, enterococcus

52
Q

Do not drain what two abscesses in the body?

A

Lung abscess

Entamoebic liver abscess

53
Q

Mexico vacation. RUQ pain and large liver cysts found

Dx and treatment

A

Enchinococcus from dog fevers. Tx with albendazole and remove ENTIRE cyst.

54
Q

Isolated thrombocytopenia (bleeding gums, petechiae, nosebleeds)

A

ITP

55
Q

Hemolytic anemia (jaundice, inc indirect Br, LDHm decor haptoglobin

A

Hereditary spherocytosis

56
Q

Liver failure - contraindication to surgery if…
Br >__
PT >__
Ammonia >___

A

Br >2
PT >16
Ammonia > 150

Shelf - Surgery (16 decks)

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