Essentials Flashcards
Prevents air from entering and fluid from siphoning back
Underwater seal drainage (i.e. Chest tube)
Drains through a tube to a reservoir at a lower level
Gravity drainage (i.e. Foley)
Drains large volumes of fluids (GI) and promotes closure of dead space.
Suction drainage (i.e. Jackson-Pratt drain)
One lumen for suction, one for irrigation allows drainage of particulate matter, abscess debris or as continuous irrigation catheter
Sump drain (i.e. NG tube)
Unsealed on both ends, used for contaminated cases
Penrose drain
Used for pneumothorax, hemothorax
Chest tube
Used for non functional GI tract > 1-2 days, decompresses, determines fluid loss
Sump tube/NG tube
Used for large raw surfaces to be kept opposed i.e. mastectomies, skin flaps
Suction drainage
What can isolate a drain from tissues
Foreign body reaction
Used for feeding purposes between skin and stomach
Gastrostomy tube/PEG
Used for compression of esophageal varices
Gastroesophageal balloon tamponade tube
Tx for SBO
First time
Recurrent
First: laparotomy, lysis of adhesions
Recurrent: long intestinal tube
Used for feeding from skin to jejunum
Jejunostomy tube
Tx for colonic ileus (cecum d>12cm)
For colonic obstruction
Ileus: cecostomy tube
Obstruction: proximal diverting colostomy
Tx for sigmoid volvulus
Or for colonic ileus
Rectal tube (transanally) under sigmoidoscopic visualization
Leave for several days or pressure necrosis
Placed in int jugular, svc or femoral vein
Complication - bacteremia
Central venous catheter
Placed in intrathoracic vein from antecubital vein
Peripherally inserted central catheter
Prolonged venous access, provokes ingrowth of surrounding tissue
For chemotherapy, hemodialysis, hyperalimentation
Cuffed central venous catheter
For long term dialysis or management of ascites in pt with malignancy
Peritoneal dialysis catheter
How to stage Hodgkin’s disease
Staging laparotomy
How to stage upper abdominal tumors
Laparoscopy
Therapy for local tumor, lymph nodes
Surgery and radiation
Therapy for metastatic tumor, system wide
Chemotherapy, immunotherapy
Multimodal therapy for breast ca
Surgery and radiation for local control and staging
Chemotherapy for positive nodes
Multimodal therapy for pancoast tumor
Preop radiation for spread into brachial plexus
Surgical resection
Multimodal therapy for extremity sarcoma
Incisional biopsy for diagnosis Preop radiation Radical local resection Postop radiation Chemotherapy
Tx for low grade neoplasm
I.e. Basal cell, mixed tumor of parotid
Wide local resection
Tx for deeply invading neoplasms
I.e. Sarcoma
Radical local resection
Tx for tumors that met to regional lymph nodes
I.e. Colon cancer
Radical resection with en bloc excision of lymphatic drainage
Tx for locally extensive disease with low likelihood of metastatic spread
I.e. Advanced rectal, cervical, bladder, uterine cancers
Super radical resection
Removal of all local tissue and lymphatics
Tx for advanced ovarian cancer
Debulking resection
Made more susceptible to chemo and radiation
General principles of postop management
6 things
- Daily examination, incl wound
- Remove tubes asap
- Early ambulation
- Monitor fluid balance, electrolytes
- Adequate but not excessive pain meds
- Good nursing care
Causes of post op fever
Day 1-3: atelectasis, pneumonia, pulmonary problems Day 3-5: UTI Day 5-8: wound infection DVT, PE, thrombophlebitis Drug fever (esp abx)
Tx for atelectasis
Incentive spirometry, coughing, deep breathing and ambulation
Collapse of lobes- NT suction, bronchoscopy to remove secretions
No abx unless infection present
What causes wound infections before days 5-8
Streptococci, clostridium
Pattern of volume flux post op
Post op hypovolemia from third spacing
Day 4-5 hypervolemia
Tx for surgical infection
Drainage, debridement, antibiotics
Most common organism infecting prosthesis
Staphylococci
Timing of prophylactic abx
1-2 hrs preop to 6-24 hrs postop
Most common sites of intraabdominal abscess
- Subphrenic
- Subhepatic
- Lateral gutters posteriorly
- Pelvis
- Periappendiceal, pericolonic
- Multiple sites in 15%
Signs of abdominal abscess
Spiking fevers, pain, leukocytosis in 2nd week postop
Can result in sepsis
Approach to drain pelvic abscess
Transrectally or through superior vagina
Approach to draining subphrenic abscess
Posteriorly through 12th rib
Most common organism in cellulitis
Streptococci
Tetanus prophylaxis after penetrating injury
If immune: booster if > 5 years
If not immune: 3 doses, dose 1 and 6 months
If not immune and dirty wound: tetanus Ig and 3 doses at separate site
Tx for suspected C. tetani infection
Prophylactic PCN in high doses
Hemorrhagic bullae, progressive toxicity, foul-smelling serous discharge, air in soft tissues
Necrotizing fasciitis
Organisms causing nec fasc
Microaerophilic streptococci
Staphylococci
Gram-neg aerobes and anaerobes
Upper GI surgery abx prophylaxis
Obstruction, blood, achlorhydria or malignancy
Cephalosporins or fluoroquinolones
Biliary tract surgery abx prophylaxis
Elective chole - cephalosporin
Common duct stones, cholangitis, empyema or gangrene of GB - cephalosporin or penicillin combination
E. coli, S. faecalis, salmonella, c. perfringens
Colon and rectal surgery abx prophylaxis
Mechanical removal preop - mannitol, polyethylene glycol
Oral abx 10-22 hrs preop - neomycin, erythromycin
Emergencies - IV abx, no primary closure
Urologic surgery abx prophylaxis when
Given perioperatively
Vascular surgery abx prophylaxis
Perioperative cephalosporin
For s. aureus, s. epidermidis
Amoxicillin if pt undergoes later procedure with bacteremia (i.e. Dental extraction)
Complications of cardiac surgery
Sternal osteomyelitis and dehiscence
Prosthetic valve endocarditis
Same prophylaxis as vascular surgery
Prophylaxis for pulmonary resections
Abx against gram-pos cocci
Infection complication in orthopedic surgery
Slime-forming staphylococci
Abx tx for deep burns
Assure tetanus prophylaxis
Penicillin G if group A strep infection (first 5 days)
Topical abx on uninjured tissue
Tx for suppurative thrombophlebitis
Vein excision
Tx for bites
Penicillin
Esophageal atresia fistula
Tracheoesophageal
Anastomotic leak fistula
Colocutaneous fistula
Splenectomy fistula complication
Pancreaticocutaneous fistula
Crohn’s disease fistulas
Enterovesical, ileosigmoid fistula
Sigmoid colon cancer fistula
Colovesical fistula
Pelvic irradiation (cervical ca) fistula
Enterovaginal fistula
Pancreatic fistula leak causes what
Metabolic acidosis
