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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

25
Electrolyte abnormality: bones/groans/psycho, shortened QT
HyperCa
26
Maintenance IVFs: Up to 10kg Next 10kgs Above 20
D5 1/2 NS + 20KCl (if peeing) First 10kgs = 100mL/kg/day Next 10kgs = 50 Above 20 = 20
27
Worry about what most in circumferential burns?
Compartment syndrome
28
Hep wont work in...
AT3 deficiency, HIT (low platelets, clots... tx with leopard in or agatroban)
29
Parkland formula for adults v. Kids
Adults - kg x %BSA x (3-4) | Children - kg x %BSA x (2-4)
30
What topical antibiotic for burns does not penetrate eschar and can cause leukopenia?
Silver sulfadiazine
31
What topical antibiotic for burns does penetrate the eschar but hurts like hell?
Mafenide
32
What topical antibiotic for burns does not penetrate eschar and can cause hypoK and hypoNa?
Silver nitrate
33
Urine dipstick positive for blood but microscopic exam negative for RBCs. Dx and check ___
Dx - rhabdo | Check K+ (released when cells break)
34
Zone 3 neck trauma - define and how do you w/u?
Above angle of mandible | W/u: aortography and triple endoscopy
35
Zone 2 neck trauma - define and how do you w/u?
Angle of mandible to the carotid | W/u with 2D doppler +/- exploratory surgery
36
Zone 1 neck trauma - define and how do you w/u?
Below the carotid | W/u with aortography
37
Kehr sign
Referred pain in left shoulder from ruptured diaphragm
38
Handlebar sign
Epigrastric bruising and pain - pancreatic rupture
39
Retroperitoneal fluid found. Stable pt with epigastric pain
Duodenal rupture
40
Pattern of nec fasc - fever 104 in POD1
SubQ tissue along scarpa's fascia
41
Nec fasc MCC bugs
GABHS, Clostridium perfrigens
42
>____cm on lateral decubitus or CXR pleural effusion, do what?
>1cm, do thoracentesis
43
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?
Light's criteria Transudative effusion
44
Valsalva does ____ to preload AS v. HOCM
Decreases preload AS - murmur gets softer with decreased preload HOCM - murmur obstruction gets worse with decreased preload
45
R v. L murmur - change in relationship to inspiration
Inhale = increased blood to RA/RV; decreased blood to LA/LV | R murmurs get louder with inspiration
46
Complications of pancreatitis
Pseudocyst (no cells in cyst) Hemorrhage Abscess Third spacing --COT--> ARDS
47
Chronic pancreatitis --> ______ --> gastric varies
Splenic Vein Thrombosis
48
RUQ pain, high Br, high alk-phos
Choledocholithiasis (blocked CBD) See on US Tx ERCP or surgery
49
RUQ pain, fever, jaundice, HypoTN, AMS
Ascending cholangitis (complication of choledocholithiasis) Abx and ERCP
50
Woman on OCP --> palpable and mass or spontaneous rupture --> hemorrhagic shock Dx? Tx?
Hepatic adenoma Dx - US or MRI Tx - D/c OCPs. Resect if large.
51
MCC of bacterial abscess (three)
E. coli, bactericides, enterococcus
52
Do not drain what two abscesses in the body?
Lung abscess | Entamoebic liver abscess
53
Mexico vacation. RUQ pain and large liver cysts found Dx and treatment
Enchinococcus from dog fevers. Tx with albendazole and remove ENTIRE cyst.
54
Isolated thrombocytopenia (bleeding gums, petechiae, nosebleeds)
ITP
55
Hemolytic anemia (jaundice, inc indirect Br, LDHm decor haptoglobin
Hereditary spherocytosis
56
Liver failure - contraindication to surgery if... Br >__ PT >__ Ammonia >___
Br >2 PT >16 Ammonia > 150

Shelf - Surgery (16 decks)

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